• Gastrointestinal Cancer Disease Site Group. Earle CC, Maroun J, Zuraw L. Neoadjuvant or adjuvant therapy for resectable gastric cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 May 21 [online update]. 21 p. (Practice guideline; no. 2-14). [79 references]

• Following surgical resection, patients whose tumours penetrated the muscularis propria or involved regional lymph nodes should be considered for adjuvant combined chemoradiotherapy. The current standard protocol consists of one cycle of 5-fluorouracil (FU) (425 mg/m²/day) and leucovorin (20 mg/m²/day) in a daily regimen for five days, followed one month later by 4,500 cGy (180 cGy/day) of radiation given with 5-FU (400 mg/m²/day) and leucovorin (20 mg/m²/day) on days 1 through 4 and the last three days of radiation. One month after completion of radiation, two cycles of 5-FU (425 mg/m²/day) and leucovorin (20 mg/m²/day) in a daily regimen for five days are given at monthly intervals.
• There is no evidence on which to make a recommendation for patients with node-negative tumours that have not penetrated the muscularis propria.
• For patients unable to undergo radiation, adjuvant chemotherapy alone may be of benefit, particularly for patients with lymph node metastases. The optimal regimen remains to be defined.
• There is insufficient evidence from randomized trials to recommend neoadjuvant chemotherapy, or neoadjuvant or adjuvant radiation therapy or immunotherapy, either alone or in combination, outside of a clinical trial.

None provided

The recommendations are supported by randomized controlled trials and meta-analyses.

• Gastrointestinal Cancer Disease Site Group. Earle CC, Maroun J, Zuraw L. Neoadjuvant or adjuvant therapy for resectable gastric cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 May 21 [online update]. 21 p. (Practice guideline; no. 2-14). [79 references]

Not applicable: The guideline was not adapted from another source.

2000 Dec 6 (updated online 2003 May)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario, Ontario Ministry of Health and Long-Term Care

Provincial Gastrointestinal Cancer Disease Site Group

Members of the Gastrointestinal Cancer Disease Site Group disclosed potential conflict of interest information.

None available

This NGC summary was completed by ECRI on June 23, 2003. The information was verified by the guideline developer as of July 16, 2003. This summary was updated by ECRI on January 23, 2004. The information was verified by the guideline developer as of February 23, 2004.