National Comprehensive Cancer Network

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UPDATES: NCCN Guidelines® and NCCN Compendium®

NCCN Flash Update sent September 17, 2013

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

  • Workup (REC-2)
    • Footnote "g" is new to the page: PET-CT does not supplant a contrast-enhanced diagnostic CT scan. PET-CT should only be used to evaluate an equivocal finding on a contrast-enhanced CT scan or in patients with strong contraindications to IV contrast.
  • Resectable synchronous metastases (REC-5)
    • Primary treatment option of staged or synchronous resection of metastases + rectal lesion removed.
  • Surveillance (REC-7)
    • Consider proctoscopy recommendation modified to every 6 mo x 3-5 y for patients status post LAR or transanal excision.
  • Continuum of Care – Chemotherapy for Advanced or Metastatic Disease
    • Bevacizumab added as an option in combination with FOLFOXIRI in initial therapy for advanced or metastatic disease. The category designation remains 2B. (REC-E 3 of 9)
    • Footnote 3, last sentence modified: There are insufficient no data to support the routine use of Ca/Mg infusion to prevent oxaliplatin related neurotoxicity and therefore should not be done. (REC-E 5 of 9)
    • Footnote 16 added: Regorafenib is a treatment option for patients who have progressed through all available regimens (e.g. KRAS mutant or KRAS WT with previous exposure to anti-EGFR inhibitor). (REC-E 5 of 9)

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

To access the NCCN Biomarkers Compendium™, please visit

To view the NCCN Guidelines for Patients®, please visit

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