National Comprehensive Cancer Network

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NCCN Guidelines and Compendium Updated

Flash Update Sent May 18, 2012
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Esophageal and Esophagogastric Junction Cancers. These NCCN Guidelines® are currently available as Version 1.2012.

  • Workup:
    • The following recommendations were added: Endoscopic mucosal resection (EMR) may contribute to accurate staging of early stage cancers" and "Smoking cessation advice, counseling, and pharmacotherapy".
  • Primary Treatment for Medically Fit Patients with Locoregional disease
    • EMR and ablation is now listed as the preferred primary treatment for T1a tumors over esophagectomy.
    • Preoperative chemoradiation is now listed as the preferred primary treatment for T2-T4a, Any (regional) N tumors.
    • For patients who received preoperative chemoradiation, the recommendation "Upper GI endoscopy and biopsy" for response assessment is now listed as "optional".
  • Postoperative Treatment for Patients Who Have Not Received Preoperative Chemoradiation or Chemotherapy
    • For patients with node-negative adenocarcinoma of the distal esophagus or esophagogastric junction (EGJ), "Consider chemoradiation" was added as an option following R0 resection for selected patients with T2, N0 tumors.
  • Primary Treatment for Medically Unfit Patients
    • For patients with superficial T1b tumors, the following recommendations were added as treatment options: "EMR and ablation" or "Consider chemoradiation for tumors with poor prognostic features".
  • Principles of Endoscopic Staging and Therapy
    • In the fourth bullet under "Diagnosis", the following sentence was added, "EMR can be therapeutic/diagnostic".
  • Principles of Surgery
    • A new section including the definition and management of Siewert Type I-III tumors of the EGJ was added.
  • Principles of Radiation Therapy
    • In the Fourth bullet under "Simulation and Treatment Planning" the following statement was added, "When 4D CT planning or other motion management techniques are used, margins may be modified to account for observed motion and may also be reduced if justified.
    • RT doses were clarified as follows:
      • Preoperative or Postoperative Therapy: 45-50.4 Gy (1.8-2 Gy/day)
      • Definitive Therapy: 50-50.4 Gy (1.8-2 Gy/day)

NCCN has published updates to the NCCN Guidelines for Gastric Cancer. These NCCN Guidelines are currently available as Version 1.2012.

  • Workup:
    • The following recommendations were added: Endoscopic mucosal resection (EMR) may contribute to accurate staging of early stage cancers" and "Smoking cessation advice, counseling, and pharmacotherapy".
  • Postoperative Treatment for Patients Who Have Not Received Preoperative Chemotherapy or Chemoradiation
    • Based on the results of the randomized phase III CLASSIC trial, capecitabine + oxaliplatin was added as an option following R0 resection for patients with T3, T4, Any N or Any T, N+ tumors who have undergone D2 lymph node dissection.
  • Post Treatment Assessment
    • For medically fit, unresectable or medically unfit patients following primary treatment, "Pelvic CT as clinically indicated" was added to the list of recommendations.
  • Principles of Endoscopic Staging and Therapy
    • In the fourth bullet under "Diagnosis", the following sentence was added, "EMR can be therapeutic/diagnostic".
  • Principles of Surgery
    • A new section including the definition of D1 and D2 lymph node dissections was added.


For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.