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58

59

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

5

Treatment guide

Locoregional cancer

Guide 8. Next treatment after pre- or perioperative treatment + surgery

Surgical results

Pathologic stage

What are my options?

No cancer is in the surgical margin

Any T, N0, M0

• Start follow-up care, or

• Chemotherapy if received before surgery

Any T, N1–N3, M0 • Chemotherapy if received before surgery

Cancer is in the surgical margin

Any

• Chemoradiation if not received before surgery

Some cancer remains in or near

your stomach

Any

• Chemoradiation if not received before surgery,

or

• Supportive care

Cancer is found in distant sites

Any

• Supportive care

5

Treatment guide

Locoregional cancer

Guide 8

lists options for the next treatment after

initial treatment with

chemoradiation or chemotherapy

followed by surgery. The results of surgery are used

to decide if more treatment is needed. Surgery

results include, 1) no cancer is in the surgical margin;

2) cancer is in the surgical margin; 3) not all the

cancer that the surgeon could see in or near the

stomach was removed; and 4) cancer was found in

distant sites (M1 score).

When no cancer is in the surgical margin, options are

also based on the pathologic stage. That's the cancer

stage after surgery. For cancers rated N0, no more

treatment is needed unless you had chemotherapy

before surgery. If you received chemotherapy with or

without radiation before surgery, more chemotherapy

is advised for cancers scored N0, N1, N2, or N3.

The recommended regimens for chemotherapy after

surgery are:

• ECF (epirubicin, cisplatin, and fluorouracil),

• Epirubicin, oxaliplatin, and fluorouracil,

• Epirubicin, cisplatin, and capecitabine, and

• Epirubicin, oxaliplatin, and capecitabine.

If cancer is found in the surgical margin,

chemoradiation is advised if you didn’t receive

it before surgery. Chemoradiation will treat any

cancer that may remain in your body. Likewise, if

your surgeon wasn’t able to remove all the cancer

in or near your stomach, chemoradiation is one of

two options. In these cases, chemotherapy with

infusional 5-FU or capecitabine before and after

fluoropyrimidine-based chemoradiation is advised.

You may receive supportive care. It is a second option

when cancer remains in or near your stomach after

surgery. It is also advised if M1 cancer is found during

surgery. Supportive care is addressed in the next

section,

Metastatic cancer

.