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中国胃癌放疗指南(2020版)
中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放疗专业委员会
Radiotherapy guidelines for gastric cancer in China (2020ed)
Radiooncologist Branch of Chinese Medical Doctor Association, Radiation Oncology Therapy Branch of the Chinese Medical Society, Cancer Radiotherapy Professional Committee of China Anti-Cancer Association
Abstract：Gastric cancer is one of the most common malignant tumors in China, and most of the patients are in the advanced stage when diagnosed. Radiotherapy plays an important role in the multidisciplinary treatment strategy. The panel of this guideline for gastric cancer in China included 34 experts from 22 leading hospitals and from treatment related departments as radiation oncology, surgical oncology, medical oncology and radiology. As the first guideline of radiotherapy for gastric cancer in China, it will provide important basis and reference for radiotherapy and comprehensive treatment of gastric cancer in China. Its continuous improvement and update in clinical practice will benefit the majority of gastric cancer patients and promote the development in this field.
Radiooncologist Branch of Chinese Medical Doctor Association,Radiation Oncology Therapy Branch of the Chinese Medical Society,Cancer Radiotherapy Professional Committee of China Anti-Cancer Association. Radiotherapy guidelines for gastric cancer in China (2020ed)[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 989-1001.
[1] Cao M, Li H, Sun D, et al. Cancer burden of major cancers in China:a need for sustainable actions[J]. Cancer Commun (Lond). 2020, 40(5):205-210. DOI:10.1002/cac2.12025. [2] 左婷婷,郑荣寿,曾红梅,等. 中国胃癌流行病学现状[J]. 中国肿瘤临床,2017, 44(1):52-58. DOI:10.3969/j.issn.1000-8179.2017.01.881. Zuo TT, Zheng RS, Zeng HM, et al. Epidemiology of gastric cancer in China[J]. Chin Clin Oncol, 2017, 44(1):52-58. DOI:10.3969/j.issn.1000-8179.2017.01.881. [3] Cunningham D, Allum WH, Stenning SP, et al.Perioperative chemotherapy versussurgery alone for resectable gastroesophageal cancer[J]. N Engl J Med, 2006, 355(1):11-20. DOI:10.1056/NEJMoa055531. [4] Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J]. N Engl J Med, 2001, 345(10):725-730. DOI:10.1056/NEJMoa010187. [5] Lee J, Lim DH, Kim S, et al. Phase Ⅲ trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection:the ARTIST trial[J]. J Clin Oncol, 2012, 30(3):268-273. DOI:10.1200/jco.2011.39.1953. [6] Park SH, Lim DH, Sohn TS, et al. A randomized phase Ⅲ trial comparing adjuvant single-agent S1, S-1 with oxaliplatin, and postoperative chemoradiation with S-1 and oxaliplatin in patients with node-positive gastric cancer after D2 resection:the ARTIST 2 trial[J]. Ann Oncol, 2021, 32(3):368-374. DOI:10.1016/j.annonc.2020.11.017. [7] Yang Y, Xing P, Zhou N, et al. The necessity of adjuvant radiotherapy for locally advanced gastric cancer in China[J]. Transl Cancer Res, 2019, 8(2):676-682. DOI:10.21037/tcr.2019.03.11. [8] Fléjou JF. WHO Classification of digestive tumors:the fourth edition[J]. Ann Pathol, 2011, 31(5 suppl):S27-31. DOI:10.1016/j.annpat.2011.08.001. [9] Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual:continuing to build a bridge from a population-based to a more"personalized" approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2):93-99. DOI:10.3322/caac.21388. [10] Kim YK, Lee MW, Lee WJ, et al. Diagnostic accuracy and sensitivity of diffusion-weighted and of gadoxetic acid-enhanced 3-T MR imaging alone or in combination in the detection of small liver metastasis (≤ 1.5cm in diameter)[J]. Invest Radiol, 2012, 47(3):159-166. DOI:10.1097/RLI.0b013e31823a1495. [11] Wang FH, Zhang XT, Li YF, et al. The chinese society of clinical oncology (CSCO):clinical guidelines for the diagnosis and treatment of gastric cancer, 2021[J]. Cancer Commun (Lond), 2021, 41(8):747-795. DOI:10.1002/cac2.12193. [12] Filik M, Kir KM, Aksel B, et al. The Role of 18F-FDG PET/CT in the primary staging of gastric cancer[J]. Mol Imag Radionucl Ther, 2015, 24(1):15-20 DOI:10.4274/mirt.26349. [13] Botet JF, Lightdale CJ, Zauber AG, et al. Preoperative staging of gastric cancer:comparison of endoscopic US and dynamic CT[J]. Radiology, 1991, 181(2):426-432. DOI:10.1148/radiology.181.2.1924784. [14] Bentrem D, Gerdes H, Tang L, et al. Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer[J]. Ann Surg Oncol, 2007, 14(6):1853-1859. DOI:10.1245/s10434-006-9037-5. [15] Akiyama M, Ota M, Nakajima H, et al. Endoscopic mucosal resection of gastric neoplasms using a ligating device[J]. Gastrointest Endosc, 1997, 45(2):182-186. DOI:10.1016/s0016-5107(97)70245-1. [16] Japanese gastric cancer treatment guidelines 2010(ver. 3)[J]. Gastric Cancer, 2011, 14(2):113-123. DOI:10.1007/s10120-011-0042-4. [17] Terashima M, Iwasaki Y, Mizusawa J, et al. Randomized phase Ⅲ trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer, the short-term safety and surgical results:Japan Clinical Oncology Group Study (JCOG0501)[J]. Gastric Cancer, 2019, 22(5):1044-1052. DOI:10.1007/s10120-019-00941-z. [18] Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):a phase 3 open-label, randomised controlled trial[J]. Lancet, 2012, 379(9813):315-321. DOI:10.1016/S0140-6736(11)61873-4. [19] Ji J, Shen L, Li Z, et al. LBA42:perioperative chemotherapy of oxaliplatin combined with S-1(SOX) versus postoperative chemotherapy of SOX or oxaliplatin with capecitabine (XELOX) in locally advanced gastric adenocarcinoma with D2 gastrectomy:a randomized phase Ⅲtrial (RESOLVE trial)[J]. Ann Oncol, 2019, 30(5):877. DOI:10.1093/annonc/mdz394.033. [20] van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J]. N Engl J Med, 2012, 366(22):2074-2084. DOI:10.1056/NEJMoa1112088. [21] Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial[J]. Lancet Oncol, 2019, 393(10184):1948-1957. DOI:10.1016/S0140-6736(18)32557-1. [22] Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase Ⅲ trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer:CALGB 9781[J]. J Clin Oncol, 2008, 26(7):1086-1092. DOI:10.1200/JCO.2007.12.9593. [23] Khushalani NI, Leichman CG, Proulx G, et al. Oxaliplatin in combination with protracted-infusion fluorouracil and radiation:report of a clinical trial for patients with esophageal cancer[J]. J Clin Oncol, 2002, 20(12):2844-2850. DOI:10.1200/JCO.2002.12.032. [24] 中华人民共和国国家卫生和计划生育委员会. 胃癌规范化诊疗指南(试行)[J]. 中国医学前沿杂志(电子版),2013, 5(8):56-63. DOI:10.3969/j.issn.1674-7372.2013.08.012. The National Health and Family Planning Commission of the People′s Republic of China. Guidelines for standardized diagnosis and treatment of gastric cancer (trial)[J]. Chin J Front Med Sci (Elec V), 2013, 5(8):56-63. DOI:10.3969/j.issn.1674-7372.2013.08.012. [25] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014(ver. 4)[J]. Gastric Cancer, 2017, 20(1):1-19. DOI:10.1007/s10120-016-0622-4. [26] Biondi A, D′ Ugo D, Cananzi FCM, et al. Does a minimum number of 16 retrieved nodes affect survival in curatively resected gastric cancer？[J]. Eur J Surg Oncol, 2015, 41(6):779-786. DOI:10.1016/j.ejso.2015.03.227. [27] Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenichilus and effect of splenectomy in proximal gastric cancer[J]. Anticancer Res, 2009, 29(8):3347-3351. [28] Eom BW, Joo J, Kim YW, et al. Improved survival after adding dissection of the superior mesenteric vein lymph node (14v) to standard D2 gastrectomy for advanced distal gastric cancer[J]. Surgery, 2014, 155(3):408-416. DOI:10.1016/j.surg.2013.08.019. [29] Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer[J]. N Engl J Med, 2008, 359(5):453-462. DOI:10.1056/NEJMoa0707035. [30] Wang J, Xu R, Li J, et al. Randomized multicenter phase Ⅲ study of a modified docetaxel and cisplatin plus fluorouracil regimen compared with cisplatin and fluorouracil as first-line therapy for advanced or locally recurrent gastric cancer[J]. Gastric Cancer, 2016, 19(1):234-244. DOI:10.1007/s10120-015-0457-4. [31] Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA):a phase 3, open-label, randomised controlled trial[J]. Lancet, 2010, 376(9742):687-697. DOI:10.1016/S0140-6736(10)61121-X. [32] Yoshida K, Kodera Y, Kochi M, et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage Ⅲ gastric cancer:interim analysis of JACCRO GC-07, a randomized controlled trial[J]. J Clin Oncol, 2019, 37(15):1296-1304. DOI:10.1200/JCO.18.01138. [33] Sumpter K, Harper-Wynne C, Cunningham D, et al. Report of two protocol planned interim analyses in a randomised multicentre phase Ⅲ study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF[J]. Br J Cancer, 2005, 92(11):1976-1983. DOI:10.1038/sj.bjc.6602572. [34] Li ZY, Koh CE, Bu ZD, et al. Neoadjuvant chemotherapy with FOLFOX:improved outcomes in Chinese patients with locally advanced gastric cancer[J]. J Surg Oncol, 2012, 105(8):793-799. DOI:10.1002/jso.23009. [35] Kochi M, FujII M, Kanamori N, et al. Phase Ⅱ study of neoadjuvant chemotherapy with S-1 and CDDP in patients with lymph node metastatic stage Ⅱ or Ⅲ gastric cancer[J]. Am J Clin Oncol, 2017, 40(1):17-21. DOI:10.1097/COC.0000000000000058. [36] Eddin S, Batran AL. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric and EGJ cancer[J]. ASCO, 2017, Abstract 4004. [37] Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD):an international, randomised, multicentre, placebo-controlled, phase 3 trial[J]. Lancet, 2014, 383(9911):31-39. DOI:10.1016/S0140-6736(13)61719-5. [38] Wilke H, Muro K, Van Cutsem E, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW):a double-blind, randomised phase 3 trial[J]. Lancet Oncol, 2014, 15(11):1224-1235. DOI:10.1016/S1470-2045(14)70420-6. [39] Li J, Qin S, Xu J, et al. Randomized, Double-blind, placebo-controlled phase Ⅲ trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction[J]. J Clin Oncol, 2016, 34(13):1448-1454. DOI:10.1200/JCO.2015.63.5995. [40] Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2):a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2017, 390(10111):2461-2471. DOI:10.1016/S0140-6736(17)31827-5. [41] Shitara K, özgüroğlu M, Bang YJ, et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061):a randomised, open-label, controlled, phase 3 trial[J]. Lancet, 2018, 392(10142):123-133. DOI:10.1016/S0140-6736(18)31257-1. [42] Yang Y, Ma Y, Xiang X, et al. The prognostic value of the lymph node ratio for local advanced gastric cancer patients with intensity-modulated radiation therapy and concurrent chemotherapy after radical gastrectomy in China[J]. Radiat Oncol, 2020, 15(1):237. DOI:10.1186/s13014-020-01687-0. [43] Zhao L, Li J, Bai C, et al. Multi-modality treatment for patients with metastatic gastric cancer:a real-world study in China[J]. Front Oncol, 2019, 9:1155. DOI:10.3389/fonc.2019.01155. [44] Tey J, Choo BA, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era[J]. Medicine (Baltimore), 2014, 93(22):e118. DOI:10.1097/MD.0000000000000118. [45] Matzinger O, Gerber E, Bernstein Z, et al. EORTC-ROG expert opinion:radiotherapy volume and treatment guidelines for neoadjuvant radiation of adenocarcinomas of the gastroesophageal junction and the stomach[J]. Radiother Oncol, 2009, 92(2):164-175. DOI:10.1016/j.radonc.2009.03.018. [46] National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology:esophageal and esophagogastric junction cancers, version 3. 2021[DB/OL][2021-07-06]. http://www.nccn.org. [47] National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology:gastric cancer, version 4. 2021[DB/OL].[2021-07-06]. http://www.nccn.org. [48] Leong T, Smithers BM, Haustermans K, et al. TOPGEAR:a randomized, phase Ⅲ trial of perioperative ecf chemotherapy with or without preoperative chemoradiation for resectable gastric cancer:interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG[J]. Ann Surg Oncol, 2017, 24(8):2252-2258. DOI:10.1245/s10434-017-5830-6. [49] Stahl M, Walz MK, Riera-Knorrenschild J, et al. Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET):long-term results of a controlled randomised trial[J]. Eur J Cancer, 2017, 81(2):183-190. DOI:10.1016/j.ejca.2017.04.027. [50] Ajani JA, Winter K, Okawara GS, et al. Phase Ⅱ trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904):quality of combined modality therapy and pathologic response[J]. J Clin Oncol, 2006, 24(24):3953-3958. DOI:10.1200/JCO.2006.06.4840. [51] Lee JH, Paik YH, Lee JS, et al. Candidates for curative resection in advanced gastric cancerpatients who had equivocal para-aortic lymph node metastasison computed tomographic scan[J]. Ann Surg Oncol, 2006, 13(9):1163-1167. DOI:10.1245/s10434-006-9002-3. [52] Sun J, Sun YH, Zeng ZC, et al. Consideration of the role of radiotherapy for abdominal lymph node metastases in patients with recurrent gastric cancer[J]. Int J Radiat Oncol Biol Phys, 2010, 77(2):384-391. DOI:10.1016/j.ijrobp.2009.05.019. [53] Adachi Y, Sakino I, Matsumata T, et al. Clinical results and prognostic factors of radiologically node-positive gastric carcinoma[J]. J Clin Gastroenterol, 1999, 28(2):140-143. DOI:10.1097/00004836-199903000-00011. [54] Suh JH, Kotecha R, Chao ST, et al. Current approaches to the management of brain metastases[J]. Nat Rev Clin Oncol, 2020, 17(5):279-299. DOI:10.1038/s41571-019-0320-3. [55] de Vin T, Engels B, Gevaert T, et al. Stereotactic radiotherapy for oligometastatic cancer:a prognostic model for survival[J]. Ann Oncol, 2014, 25(2):467-471. DOI:10.1093/annonc/mDT537. [56] 日本胃癌学会. 胃癌治疗指南[M].5版. 东京:金原出版株式会社,2018. The Japanese Gastric Cancer Society. Guidelines for gastric cancer treatment[M]. 5th ed. Tokyo:Jinhara Publishing, 2018. [57] Martin L, Senesse P, Gioulbasanis I, et al. Diagnostic criteria for the classification of cancer-associated weight loss[J]. J Clin Oncol, 2015, 33(1):90-99. DOI:10.1200/JCO.2014.56.1894. [58] Zhou J, Hiki N, Mine S, et al. Role of prealbumin as a powerful and simple index for predicting postoperative complications after gastric cancer surgery[J]. Ann Surg Oncol, 2017, 24(2):510-517. DOI:10.1245/s10434-016-5548-x. [59] Migita K, Takayama T, Matsumoto S, et al. Impact of being underweight on the long-term outcomes of patients with gastric cancer[J]. Gastric Cancer, 2016, 19(3):735-743. DOI:10.1007/s10120-015-0531-y. [60] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002):a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3):321-336. DOI:10.1016/s0261-5614(02)00214-5. [61] Bauer J, Capra S, Ferguson M. Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer[J]. Eur J Clin Nutr, 2002, 56(8):779-785. DOI:10.1038/sj.ejcn.1601412.
2021, Vol. 30 
