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Gastric Cancer Treatment Guidelines in Japan: principles

Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena.   Italy.

July 2002.     Review Article.

Recent development in treatment modalities for gastric cancer have allowed the selection of a variety of treatments, and this has resulted in some confusion in daily practice. The Japan Gastric Cancer Association issued the first edition of "Gastric Cancer treatment guidelines" in March 2001 to provide a common basis of understanding of the extent of disease and selection of proper treatment among doctors, patients, and their families.


1) GLs provide standardized indications of the optimal treatment modality according to the clinical stage of each patient, but do not deal with the technical aspects of treatment.

2) GLs are principally described based on evidence-based medicine ( EBM ) as much as evidence is available, although the GL Development Committee sometimes faced difficulties because of lack of evidence in regard to various aspects of treatments.

3) Survival time is the primary endpoint of treatment results, although relief of symptoms, tumor shrinkage, and quality of life ( QOL ) are considered to be secondary endpoints.

4) Recommendations for daily practice are listed in the GLs, and some promising, but not yet confirmed, treatment modalities are also recommended to be investigated as clinical trials.

5) The JGCA provides GLs for all doctors and patients, who are going to make their treatment decisions on a common basis. GLs will faciltate the mutual understanding of treatment decisions between doctors and patients or their families. If doctors are planning to offer treatments different from those in the GLs, they are expected to explain the reasons for this difference to patients, and to when they obtain informed consent.

6) Treatment GLs should be always reviewd and revised associated with developments in the treatment of gastric cancer. A panel of the GL Development Committee of the JGCA is in charge of periodical review and revision, and discussion and proposal from members of the JGCA and JGCA are always welcome for this purpose ( 1 ).


1) Toshifusa Nakajima. Gastric cancer treatment guidelines in Japan. Gastric Cancer, 2002, 5: 1-5.

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