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World J Gastrointest Oncol. Jan 15, 2020; 12(1): 37-53
Published online Jan 15, 2020. doi: 10.4251/wjgo.v12.i1.37
Interpretation of the development of neoadjuvant therapy for gastric cancer based on the vicissitudes of the NCCN guidelines
Xian-Ze Wang, Zi-Yang Zeng, Xin Ye, Juan Sun, Zi-Mu Zhang, Wei-Ming Kang
Xian-Ze Wang, Zi-Yang Zeng, Xin Ye, Juan Sun, Zi-Mu Zhang, Wei-Ming Kang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Author contributions: Wang XZ wrote the manuscript and prepared the tables; Zeng ZY organized the references; Ye X contributed to verifying the accuracy of the manuscript; Sun J and Zhang ZM contributed to the writing of the manuscript; Kang WM designed the aim of the manuscript and wrote the manuscript.
Supported by Beijing Municipal Science and Technology Project, No. D171100006517004; CSCO-ROCHE Research Fund, No. Y-2019Roche-015.
Conflict-of-interest statement: All of the authors declare no conflicts of interest to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Ming Kang, MD, Professor, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China. kangweiming@163.com
Received: August 3, 2019
Peer-review started: August 3, 2019
First decision: August 23, 2019
Revised: September 9, 2019
Accepted: September 26, 2019
Article in press: September 26, 2019
Published online: January 15, 2020
Processing time: 149 Days and 22.9 Hours
Abstract

Gastric cancer is one of the most common digestive system tumors in China, and locally advanced gastric cancer (LAGC) accounts for a high proportion of newly diagnosed cases. Although surgery is the main treatment for gastric cancer, surgical excision alone cannot achieve satisfactory outcomes in LAGC patients. Neoadjuvant therapy (NAT) has gradually become the standard treatment for patients with LAGC, and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate, but it also significantly improves the long-term prognosis of patients. Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies, and the regimens have also been evolved in the past decades. Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide, here, we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019, and also discuss the future of NAT.

Keywords: Gastric cancer; Locally advanced gastric cancer; Neoadjuvant therapy; Neoadjuvant chemotherapy; Neoadjuvant chemoradiotherapy; NCCN guidelines

Core tip: Surgical excision is one of the most effective ways in treating nonmetastatic gastric cancer. However, surgery alone cannot achieve satisfactory therapeutic effects in locally advanced gastric cancer (LAGC), and the 5-year survival rate of LAGC patients is less than 50%. Neoadjuvant therapy (NAT) aims at improving the surgical and R0 resection rate and decreasing the recurrence of micrometastases of LAGC. The strategies of NAT have been continuously developed in the past decades, and the evolvements can be reflected from the vicissitudes of the NCCN guidelines. Moreover, targeted therapy and individualized treatment may be the next hotspots of NAT, and may further improve the prognosis of LAGC patients.