Practice Guidelines in Oncology - Gastric Cancer

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® Practice Guidelines NCCN in Oncology – v.1.2007 Medically fit, b potentially resectable Medically fit, b unresectable Medically unfit b d POSTLAPAROSCOPY STAGING M0 M1 M0 M1 M0 M1 T1 or less (by clinical staging) T2 or higher (by clinical staging or N+) Gastric Cancer PRIMARY TREATMENT Surgery d,e Surgery RT, 45-50.4 Gy + concurrent 5-FU-based radiosensitization (category 1) or Chemotherapy f Salvage Therapy (see GAST-4) RT, 45–50.4 Gy + concurrent 5-FU-based radiosensitization (category 1) or Salvage Therapy (see GAST-4) Salvage Therapy (see GAST-4) Medically able to tolerate major abdominal surgery. Surgery as primary therapy is appropriate for T1 cancer or actively bleeding cancer, or when postoperative adjuvant therapy is preferred. eSee Principles of Surgery (GAST-A) . fSee Principles of Systemic Therapy (GAST-B) . Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. or 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. e Preoperative chemotherapyf Salvage Therapy (see GAST-4) Surgery e Guidelines Index Gastric Table of Contents Staging, MS, References Surgical Outcomes (see GAST-3) Adjunctive Treatment Postchemotherapy ± RT (see GAST-3) Adjunctive Treatment Postchemotherapy ± RT (see GAST-3) GAST-2
® Practice Guidelines NCCN in Oncology – v.1.2007 Surgical outcomes SURGICAL RESECTION R0 resection R1 resection R2 resection T1, N0 T2, N0 Gastric Cancer T3, T4 or Any T, N+ ADJUNCTIVE TREATMENT RT, 45–50.4 Gy + concurrent 5-FU-based radiosensitization (preferred) + 5-FU ± leucovorin RT, 45–50.4 Gy + concurrent 5-FU-based radiosensitization Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. or Chemotherapy or Best supportive care (poor performance status) 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. f Observe Guidelines Index Gastric Table of Contents Staging, MS, References Follow-up (see GAST-4) Observe or Chemotherapy ( 5-FU-based)/RT for selected patientsg RT, 45–50.4 Gy + concurrent 5-FU-based radiosensitization (preferred) + 5-FU ± leucovorin Follow-up (see GAST-4) Salvage Therapy (see GAST-4) M1 Salvage Therapy (see GAST-4) Restaging (preferred): � Chest x-ray Adjunctive � Abdominal CT treatment, � Pelvic imaging postchemo- (females) therapy ± RT � CBC, SMA-12 � PET/CT scan eSee Principles of Surgery (GAST-A) . fSee Principles of Systemic Therapy (GAST-B) . Complete response or major response Residual, locoregional and/or distant metastases Follow-up (see GAST-4) or Surgery, e if appropriate Salvage Therapy (see GAST-4) gHigh risk features such as poorly differentiated or higher grade cancer, lymphovascular invasion, neural invasion, or < 50 years of age. f GAST-3
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Practice Guidelines in Oncology - Gastric Cancer

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