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NCCN Clinical Practice Guidelines in Oncology for Central Nervous System Cancers and Venous Thromboembolic Disease Updated

Venous Thromboembolic Disease

An option for use of graduated compression stockings (GCS) for patients without contraindications for anticoagulation treatment was added to the Guidelines for Inpatient Venous Thromboembolism Prophylaxis. GCS were also added as a treatment option for patients with a pelvic/iliac/IVC or femoral/popliteal DVT. For patients in high risk settings (for example, patients receiving highly thrombotic antiangiogenic therapy), the recommendation for VTE prophylaxis changed from “consider” to “recommend.” Recommendations for indefinite anticoagulation were also strengthened from “consider” to “recommend” for patients with active cancer or persistent risk factors in the chronic VTE setting.

Central Nervous System Cancers

In the NCCN Guidelines for Adult Low Grade Infiltrative Supratentorial Astrocytoma/Oligodendroglioma, age ranges were adjusted so that patients who receive a maximal safe resection and are over the age of 40 are now candidates for observation, fractionated external beam radiation therapy, or consideration of chemotherapy as adjuvant treatment. Patients under the age of 40 are recommended for observation. Previously, the ages were listed as either over or under 45 years old.

For patients with glioblastoma multiforme, adjuvant treatment decisions are now based on patient performance status. For recurrence/salvage therapy in glioblastoma multiforme, bevacizumab can now be used as a single agent without irinotecan. Previously, bevacizumab was an option only when used in combination with irinotecan. For anaplastic astrocytoma/anaplastic oligodendroglioma, an analogous update was made with regards to the use of bevacizumab as a single agent; bevacizumab can now be used with or without irinotecan.