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NCCN Guidelines and Compendium Updated

Flash Update Sent December 14, 2011
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Thyroid Carcinoma. These NCCN Guidelines® are currently available as Version 1.2012.

Thyroid Carcinoma—Nodule Evaluation

  • For patients with an FNA result of "Follicular lesions of undetermined significance," observation was added as a treatment option.
  • The last sentence in footnote "h" was revised as follows: "Molecular diagnostics may be useful to allow reclassification of follicular lesions (follicular neoplasm or follicular lesions of undetermined significance) as more likely to be benign or more likely to be malignant.  If molecular testing suggests papillary thyroid carcinoma, see (PAP-1)". (A similar change was made to the Follicular Carcinoma algorithm.)


Thyroid Carcinoma: Papillary Carcinoma

    • For patients who receive a total thyroidectomy and have palpable (or biopsy positive) lymph nodes, the second bullet was revised to read "Lateral neck dissection (levels II, III, IV, and Vb, include levels I and Va if clinically involved). Consider preservation of the cervical sensory nerves." Previously this recommendation stated "Lateral neck dissection (levels III and IV, consider levels IIe and V depending on clinical and ultrasound findings). Spare spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle. Consider preservation of the cervical sensory nerves." (A similar change was also made to the Follicular Carcinoma and Hürthle Cell Carcinoma algorithms.)

    • Preoperative or Intraoperative Decision-Making Criteria: For patients with all the following features present: (i.e., Age 15-45 years, no prior radiation, no distant metastases, no cervical lymph node metastases, no extrathyroidal extension, tumor size less than 4 cm in diameter, and no aggressive variant); the guidelines recommend for primary treatment either a total thyroidectomy (category 2B) or lobectomy + isthmusectomy (category 2B). A new footnote "f" was added that states, "The majority of the panel would recommend total thyroidectomy for biopsy proven papillary thyroid carcinoma."

    • For patients with no gross residual disease in the neck after total thyroidectomy, who may or may not consider radioiodine therapy based on clinical indications, a new footnote "j" was added as follows:
      • Clinical indications regarding radioactive iodine:
    • Radioactive iodine is recommended for all patients with gross extrathyroidal extension, primary tumor size greater than 4 cm, or distant metastases.

    • Radioactive iodine is not routinely recommended for patients with either unifocal or multifocal papillary microcarcinomas (less than 1 cm) confined to the thyroid.

  • Radioactive iodine is recommended for selected patients with primary tumors ranging from 1-4 cm confined to the thyroid, high risk histologies, vascular invasion, or cervical lymph node metastases when the combination of clinical factors predicts a significant risk of recurrence or disease specific mortality.

    (A similar change was also made to the Follicular Carcinoma and Hürthle Cell Carcinoma algorithms.)


Follicular Carcinoma

  • After primary treatment (total thyroidectomy or lobectomy/isthmusectomy) for follicular neoplasm, a third pathway was added for "Papillary carcinoma." Previously only "Benign" and "Follicular carcinoma" were listed.


Medullary Thyroid Carcinoma

  • A new pathway with treatment recommendations was added for patients with "Medullary thyroid carcinoma diagnosed after initial thyroid surgery."

NCCN has published updates to the NCCN Guidelines for Pancreatic Adenocarcinoma. These NCCN Guidelines are currently available as Version 2.2012.

  • Two new sections have been added:
    • Principles of Surgical Technique (PANC-C)
    • Pathological Analysis: Specimen Orientation, Histological Sections, and Reporting (PANC-D)
  • The Discussion section has been updated to reflect the changes in the algorithm.

 

 

Flash Update Sent December 19, 2011
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Thyroid Carcinoma. These NCCN Guidelines® are currently available as Version 2.2012.

  • The Discussion section has been updated to reflect the changes in the algorithm.


Flash Update Sent December 22, 2011
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Bladder Cancer. These NCCN Guidelines® are currently available as Version 2.2012.

    • Radiosensitizing chemotherapy regimen, mitomycin C in combination with 5-fluorouracil, was changed from a category 2B recommendation to category 2A recommendation.

    • Chemotherapy as primary treatment for metastatic urothelial carcinoma of ureter and urothelial carcinoma of prostate was added.

  • The Discussion section has been updated to reflect the changes in the algorithm.


For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.