Gastric cancer is a virulent disease that is the second leading cause of cancer mortality worldwide. There is significant geographic variation in the incidence of gastric cancer, with incidence and mortality being particularly high in Japan, China, Korea, Chile, and Costa Rica. Even though the incidence rate for gastric cancer in Ontario is one of the lowest worldwide, overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada and 23%–25% in the United States for all stages combined.
Despite the considerable body of research available on chemotherapy for advanced gastric cancer, uncertainty remains. There no recognized standard treatment for gastric cancer, and there appears to be geographic variation in practice. A Cochrane Collaboration systematic review and meta-analysis on chemotherapy in advanced gastric cancer was first published in 2005 6 and updated in 2006. Because of the availability of numerous randomized trials since the publication of the Cochrane review, the Gastrointestinal Disease Site Group (gi dsg) of Cancer Care Ontario’s Program in Evidence-Based Care (pebc) decided to develop a guideline on systemic therapy for advanced gastric cancer.
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