1 From The University of Texas MD Anderson Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; St. Jude Children’s Research Hospital/University of Tennessee Health Science Center; Duke Cancer Institute; Fox Chase Cancer Center; City of Hope Comprehensive Cancer Center; Dana-Farber/Brigham and Women’s Cancer Center; Memorial Sloan-Kettering Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UCSF Helen Diller Family Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Moffitt Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; UNMC Eppley Cancer Center at The Nebraska Medical Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Roswell Park Cancer Institute; Vanderbilt-Ingram Cancer Center; Massachusetts General Hospital; and National Comprehensive Cancer Network.
The NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer provide evidence- and consensus-based recommendations for a multidisciplinary approach for the management of patients with gastric cancer. For patients with resectable locoregional cancer, the guidelines recommend gastrectomy with a D1+ or a modified D2 lymph node dissection (performed by experienced surgeons in high-volume centers). Postoperative chemoradiation is the preferred option after complete gastric resection for patients with T3-T4 tumors and node-positive T1-T2 tumors. Postoperative chemotherapy is included as an option after a modified D2 lymph node dissection for this group of patients. Trastuzumab with chemotherapy is recommended as first-line therapy for patients with HER2-positive advanced or metastatic cancer, confirmed by immunohistochemistry and, if needed, by fluorescence in situ hybridization for IHC 2+.