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NCCN Flash Updates™: NCCN Guidelines® and NCCN Compendium® Updated

NCCN Flash Update sent October 7, 2013

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Neuroendocrine Tumors. These NCCN Guidelines® are currently available as Version 1.2014.

  • Carcinoid Tumors
    • The following bullet was added to footnote "d" for resection of locoregional jejunal/ileal/colon carcinoids (CARC-1): "Ass­essment of the proximity to or involvement of the superior mesenteric artery and superior mesenteric vein."
    • Footnote "q" was added for the evaluation of bronchopulmonary and thymic carcinoids (CARC-5): "Prior to evaluating ACTH, confirm hypercortisolemia using one of the following
      • Overnight 1 mg dexamethasone suppression test with 8 am plasma cortisol
      • Repeated (2-3) midnight salivary cortisols
      • 24-hour urine free cortisol"
    • Footnote "s" was added for locoregional unresectable disease and/or distant metastases (CARC-6): "Noncurative debulking surgery might be considered in select cases."
  • Neuroendocrine Tumors of the Pancreas
    • Footnote "v" was added for locoregional unresectable disease and/or distant metastases (PanNET-7): "Noncurative debulking surgery might be considered in select cases."
  • Adrenal Gland Tumors
    • Footnote "e" was added for functional evaluation of Cushing's syndrome (AGT-1): "Prior to evaluating ACTH, confirm hypercortisolemia using one of the following:
      • Overnight 1 mg dexamethasone suppression test with 8 am plasma cortisol
      • Repeated (2-3) midnight salivary cortisols
      • 24-hour urine free cortisol"
    • Suspected Carcinoma (AGT-4): Evaluation for metastases with imaging of the chest, abdomen, and pelvis is now recommended for all tumors, regardless of size.
  • Poorly Differentiated (High Grade)/Large or Small Cell (HGNET-1)
    • The following sentence was added to footnote "b": "Cisplatin or carboplatin and etoposide are generally recommended as primary treatment."
  • Multiple Endocrine Neoplasia, Type 1
    • Footnote "h" was revised and a reference was added (MEN1-3): "Surveillance is indicated for all MEN tumors regardless of patient's tumor type. For patients at risk for bronchial or thymic carcinoid tumors, chest imaging can be considered every 1-3 y (Thakker RV, Newey PJ, Walls GV, et al. Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab 2012;97:2990-3011)."
  • Principles of Pathology for Diagnosis and Reporting of Neuroendocrine Tumors
    • Table 1 was significantly revised to reflect the grading classification systems for gastroenteropancreatic (GEP) neuroendocrine tumors and lung and thymus neuroendocrine tumors, with the addition of accompanying references (NE-A 1 of 4).
    • Ki-67 Index (NE-A 3 of 4): The following bullet was added: "It is recognized that occasionally a morphologically 'well-differentiated' NET may have a proliferation index by Ki-67, which technically falls into the 'high-grade' category by this measure alone. Clinical judgment should be used in such discordant cases. In general, this discordance should not cause reclassification of a well-differentiated NET as a 'poorly differentiated NEC.' In these cases, the tumor should be reported as a well-differentiated NET (so-called 'atypical carcinoid' terminology in lung and thymus) with the specific mitotic rate and Ki-67 proliferation index included in the report as additional information."

For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium™, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPad and Android tablets are now available! Visit NCCN.org/apps