Practice Guidelines in Oncology - Gastric Cancer

®
Practice Guidelines
NCCN in Oncology – v.1.2007
performance status. Patients should be offered only best supportive
care if they have a Karnofsky performance score of 60 or less, or an
ECOG (Eastern Cooperative Oncology Group) performance score of
3 or greater. Patients with a better performance status may be
offered best supportive care alone, chemotherapy, or a clinical trial.
Summary
Gastric cancer is rampant in several countries around the world. Its
incidence in the Western Hemisphere has been on the decline for
more than 40 years; however, the location of gastric cancer has
shifted proximally in the past 15 years. The reason for this shift is
not clear. Diffuse histology is also more common now than intestinal
type of histology. Advances have been made in staging procedures,
such as laparoscopy and endoscopic ultrasonography, and in
possible functional imaging techniques. The current TNM
classification requires an examination of at least 15 lymph nodes; a
D0 dissection is unacceptable. Patients with locoregional gastric
carcinoma should also be referred to high-volume treatment centers.
Combination chemotherapy and radiotherapy in the adjuvant setting
for a select group of patients is the new standard in the United
States.
The NCCN Gastric Cancer Guidelines provide a uniform systematic
approach to gastric cancer in the United States. We look forward to
the results of investigations of new chemotherapeutic agents,
including antireceptor agents, vaccines, gene therapy, and
antiangiogenic agents. The panel anticipates many advances in the
treatment of gastric carcinoma in the future.
Gastric Cancer
Manuscript
update in
progress
Version 1.2007, 03/09/07 © 2007 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.
Guidelines Index
Gastric Table of Contents
Staging, MS, References
Disclosures for the NCCN Gastric Cancer Guidelines
Panel
At the beginning of each panel meeting to develop NCCN
guidelines, panel members disclosed the names of companies,
foundations, and/or funding agencies from which they received
research support; for which they participate in speakers' bureau,
advisory boards; and/or in which they have equity interest or
patents. Members of the panel indicated that they have received
support from the following: AstraZeneca; Berlex; Bristol Myers-
Squibb; Discovery Laboratories, Inc; Exelixis; Genentech Inc;
ImClone; Introgen Therapeutics, Inc; National Cancer Institute; OSI
Pharmaceuticals, Inc; Pfizer Inc; Sanofi-Aventis; and U.S. Surgical.
Some panel members do not accept any support from industry. The
panel did not regard any potential conflicts of interest as sufficient
reason to disallow participation in panel deliberations by any
member.
MS-9