What are the NCCN treatment guidelines for surgically unresectable locoregional gastric cancer?

Updated: Feb 23, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

For surgically unresectable locoregional disease, NCCN recommendations are as follows:

  • Chemoradiation  or
  • Systemic therapy  or
  • Palliative management

For metastatic gastric cancer, the NCCN recommends palliative chemotherapy or entry into a clinical trial. [4]

For systemic therapy, NCCN recommendations are as follows:

  • Perioperative chemotherapy - Preferred regimens are FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel [Taxotere]) (category 1) and a fluoropyrimidine plus oxaliplatin
  • Preoperative chemoradiation - Infusional fluorouracil can be replaced with capecitabine
  • Postoperative chemoradiation in patients who received less than a D2 lymph node dissection  - Infusional fluorouracil or capecitabine before and after fluoropyrimidine-based chemoradiation
  • Postoperative chemoradiation in patients who have undergone primary D2 lymph node dissection - Preferred regimens are capecitabine and oxaliplatin (category 1) and fluorouracil and oxaliplatin
  • Chemoradiation for unresectable disease - Preferred Regimens are fluorouracil (or capecitabine) and either oxaliplatin or cisplatin

For description of chemotherapy and chemoradiotherapy regimens, see Gastric Cancer Treatment Protocols.


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