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NCCN Guidelines and Compendium Updated

NCCN Flash Update sent May 23, 2013

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Hepatobiliary Cancers. These NCCN Guidelines are currently available as Version 1.2013.

  • Global Changes:
    • A new "Principles of Surgery" page was added for the following sites: Gallbladder Cancer (GALL-A), Intrahepatic cholangiocarcinoma (INTRA-A), Extrahepatic Cholangiocarcinoma (EXTRA-A).
  • Hepatocellular Carcinoma
    • Additional Imaging: For liver nodules < 1 cm, the recommendation was clarified as "At least a 3-phase CT or MRI or CEUS every 3-6 mo." Previously it stated "MRI;US." (HCC-2)
    • Footnote "k" was revised: "Consider for surgical assessment and if transplant is a consideration, consider referral to a transplant center before biopsy. Before biopsy, evaluate if patient is a surgical or transplant candidate. If patient is a potential transplant candidate, consider referral to transplant center before biopsy." (HCC-3)
    • Footnote "u" regarding imaging surveillance is new to the algorithm: "MRI or multi-phase CT scans for liver assessment are recommended. Consider chest imaging as clinically indicated." (HCC-5)
    • Principles of Locoregional Therapy: This page was extensively revised. (HCC-C)
  • Gallbladder Cancer
    • Adjuvant treatment after resection (GALL-5)
      • "Observation" was added as an option.
      • "Consider fluoropyrimidine chemoradiation (except T1b, N0)" clarified as "...except T1a or T1b, N0)."
    • Surveillance: The recommendation changed to "Consider imaging every 6 months for 2 y if clinically indicated." (GALL-5)
  • Intrahepatic Cholangiocarcinoma:
    • Workup: "Consider viral hepatitis serologies" was added. (INTRA-1)
    • Primary Treatment for resectable disease: The recommendation changed to "Resection ± ablation." "Consider lympadenectomy for accurate staging" was added as an option. (INTRA-1)
    • Post resection status (INTRA-2)
      • Additional therapy for patients with no residual local disease (R0 resection) now includes "Fluoropyrimidine chemoradiation or Fluoropyrimidine-based or gemcitabine-based chemotherapy regimen" as treatment options.
      • For patients with microscopic margins (R1) or residual local disease (R2 resection), "Consider re-resection" and "Ablation" were removed as options for additional therapy.
    • Surveillance: The recommendation changed to "Consider imaging every 6 months for 2 y if clinically indicated."
  • Extrahepatic Cholangiocarcinoma:
    • Footnote "e" regarding biopsy is new to the algorithm: Before biopsy, evaluate if patient is a surgical or transplant candidate. If patient is a potential transplant candidate, consider referral to transplant center before biopsy. (EXTRA-1)
    • Secondary and adjuvant treatment for patients who are resected with positive margin (R1) or resected gross residual disease (R2): The recommendation was revised to "Consider fluoropyrimidine chemoradiation (brachytherapy or external beam)."(EXTRA-2)
    • Secondary and adjuvant treatment: "Carcinoma in situ at margin" was removed from the R1 and R2 resection pathway and is now grouped with and has the same treatment options as the "Resected, negative margin (R0), Negative regional nodes" pathway. (EXTRA-2)
    • Surveillance: The recommendation changed to "Consider imaging every 6 mo for 2 y if clinically indicated."(EXTRA-2)

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.com.

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