Practice Guidelines in Oncology - Gastric Cancer

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® 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
® Practice Guidelines NCCN in Oncology – v.1.2007 References 1. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2006. CA Cancer J Clin 2006;56:106-130. 2. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287-1289. 3. Levi F, La Vecchia C. Adenocarcinoma of the esophagus in Switzerland (letter). JAMA 1991;265:2960. 4. Powell J, McConkey CC. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 1991;62:440-443. 5. Reed PI. Changing pattern of esophageal cancer. Lancet 1991;338:178. 6. Powell J, McConkey CC, Gillison EW, et al. Continuing rising trend in oesophageal adenocarcinoma. Int J Cancer 2002;102:422-427. 7. Crew KD, Neugut AI. Epidemiology of upper gastrointestinal malignancies. Semin Oncol 2004;31:450-464. 8. Kubo A, Corley DA. Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States. Cancer 2002;95:2096-2102. 9. Nomura A. Stomach cancer. In: Cancer Epidemiology and Prevention, 2nd edition. Shottenfeld D, Fraumeni JF, eds. New York: NY. Oxford University Press. 1996:707-724. 10. Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol 2001;30:1415-1425. 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 11. Parkin DM, Muir CS. Cancer Incidence in Five Continents. Comparability and quality of data. IARC Sci Publ 1992:45-173. 12. Kajitani T, Japanese Research Society for the Study of Gastric Cancer. The general rules for gastric cancer study in surgery and pathology. Jpn J Surg 1981;11:127-145. 13. Fitzgerald RC, Caldas C. Clinical implications of E-cadherin associated hereditary diffuse gastric cancer. Gut 2004;53:775-778. 14. Huntsman DG, Carneiro F, Lewis FR, et al. Early gastric cancer in young, asymptomatic carriers of germ-line E-cadherin mutations. N Engl J Med 2001;344:1904-1909. 15. Japanese Research Society for Gastric Cancer. The General Rules for the Gastric Cancer Study in Surgery and Pathology, 12th ed. Tokyo: Kanahara Shuppan, 1993. 16. Roder JD, Bottcher K, Busch R, et al. Classification of regional lymph node metastasis from gastric carcinoma. German Gastric Cancer Study Group. Cancer 1998;82:621-631. 17. Leichman L, Silberman H, Leichman CG, et al. Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: A University of Southern California pilot program. J Clin Oncol 1992;10:1933-1942. 18. Ajani JA, Mayer R, Ota DM, et al. Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Natl Cancer Inst 1993;85:1839-1844. 19. Hermanek P, Wittekind C. Residual tumor (R) classification and prognosis. Semin Surg Oncol 1994;10:12-20. 20. Weber WA, Ott K. Imaging of esophageal and gastric cancer. Semin Oncol 2004;31:530-541. REF-1
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Practice Guidelines in Oncology - Gastric Cancer

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