{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T20:39:14Z","timestamp":1792528754622,"version":"4.5.0"},"reference-count":20,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is a guideline-recommended standard for patients with resectable gastric cancer or gastroesophageal junction adenocarcinoma globally. Guidance is limited on patient selection, nutritional optimization, and toxicity management within existing guidelines. This study aimed to develop an international consensus to address these management gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A modified Delphi methodology, informed by the RAND\/UCLA Appropriateness Method, was conducted virtually between March and August 2025. A multidisciplinary panel of 16 experts independently rated draft clinical statements across multiple domains. Responses were anonymized, with structured, iterative rounds of feedback and re-rating. Consensus was defined a priori as a median score of 7-9 (appropriate) or 1-3 (inappropriate) with a disagreement index \u22641.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus was reached on 66.3% of the statements. Experts agreed that patients aged &gt;70 years should not be routinely excluded from perioperative FLOT but require comprehensive assessment; inclusion of Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 is appropriate, and ECOG PS 0-2 may be considered on a case-by-case basis. Adequate organ function, correction of baseline conditions, hepatitis B screening, and dihydropyrimidine dehydrogenase testing are appropriate before FLOT initiation. Universal baseline nutritional screening and support, proactive intervention for malnourished patients, and structured physical activity were endorsed. Surgical planning was supported through multidisciplinary input, with defined perioperative windows, individualized dosing, and flexibility in pre-\/postoperative cycles. For toxicity management, the panel supported dose modification over drug omission, where possible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This Delphi consensus provides expert-driven, practice-oriented advisories codifying fitness-based selection, nutrition-forward optimization, and pragmatic toxicity management. The resulting guidance builds on current standards and provides internationally applicable consensus statements to ultimately enhance patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-26-00462","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:59:06Z","timestamp":1792526346000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Selection and Management of Patients With Resectable Gastric or Gastroesophageal Junction Cancer Receiving Perioperative FLOT: A Modified Delphi Consensus Approach"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8024-9401","authenticated-orcid":true,"given":"Anwaar","family":"Saeed","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5357-5858","authenticated-orcid":true,"given":"Yelena Y.","family":"Janjigian","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1500-9281","authenticated-orcid":true,"given":"Michael K.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Vanderbilt-Ingram Cancer Center, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2207-9552","authenticated-orcid":true,"given":"David L.","family":"DeRemer","sequence":"additional","affiliation":[{"name":"University of Florida Cancer Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-1753","authenticated-orcid":true,"given":"Andrew H.","family":"Ko","sequence":"additional","affiliation":[{"name":"University of California San Francisco (UCSF), San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Fontana","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Smyth","sequence":"additional","affiliation":[{"name":"Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid L.","family":"Shaib","sequence":"additional","affiliation":[{"name":"Northwest Georgia Oncology Centers, Marietta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1663-9901","authenticated-orcid":false,"given":"Do-Youn","family":"Oh","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3187-7393","authenticated-orcid":true,"given":"Ming-Huang","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4062-0808","authenticated-orcid":true,"given":"Samuel J.","family":"Klempner","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1655-4473","authenticated-orcid":true,"given":"Daniela","family":"Molena","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Shelby","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5044-1662","authenticated-orcid":true,"given":"Vivian E.","family":"Strong","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salah-Eddin","family":"Al-Batran","sequence":"additional","affiliation":[{"name":"Institute of Clinical Cancer Research, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5196-3630","authenticated-orcid":true,"given":"Kohei","family":"Shitara","sequence":"additional","affiliation":[{"name":"National Cancer Center Hospital East, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2018.883"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055531"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.33.0597"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30531-9"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO-25-00948"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2503701"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2012.09.025"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32557-1"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34511"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-023-02822-7"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-021-08768-7"},{"key":"e_1_3_8_13_2","volume-title":"The 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Santa Monica, CA, Rand, 2001"},{"key":"e_1_3_8_14_2","volume-title":"Within3","author":"Within3","year":"2025","unstructured":"Within3: Within3. 2025. https:\/\/within3.com\/"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.588"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12391"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001769"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.5230\/jgc.2022.22.e5"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-025-01643-5"},{"key":"e_1_3_8_20_2","unstructured":"Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Antiemesis V.1.2026. \u00a9 National Comprehensive Cancer Network Inc. 2026. All rights reserved. To view the most recent and complete version of the guideline go online to NCCN.org"},{"key":"e_1_3_8_21_2","unstructured":"Referenced with permission from the NCCN Clinical Practice Guidelines in oncology (NCCN guidelines\u00ae) for hematopoietic growth factors V.3.2026. \u00a9 national comprehensive cancer Network Inc. 2026. All rights reserved. To view the most recent and complete version of the guideline go online to NCCN.org"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP-26-00462","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:59:07Z","timestamp":1792526347000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP-26-00462"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":20,"alternative-id":["10.1200\/OP-26-00462"],"URL":"https:\/\/doi.org\/10.1200\/op-26-00462","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"value":"2688-1527","type":"print"},{"value":"2688-1535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"OP-26-00462"}}