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NCCN Flash Updates™: NCCN Guidelines® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Older Adult Oncology. These NCCN Guidelines® are currently available as Version 1.2016.

  • Disease-Specific Issues Related to Age
    • Chronic Myelogenous Leukemia is new to this section.
  • The following subtypes were updated with the addition of new information:
    • Bladder Cancer (OAO-B, 4 of 32)
      • Older patients in RTOG protocols appear to have similar response rates and disease-specific survival compared to younger patients following curative intent selective bladder preservation.
      • Older age does not appear to be associated with worse late pelvic toxicity after curative intent selective bladder preservation.
    • Breast Cancer (OAO-B, 5 of 32)
      • Multiple studies have shown that older women often do not receive “standard of care” treatment, and do not do as well as younger women with the same stage of breast cancer.
      • Women older than 75 years receive less aggressive treatment and have higher mortality from early-stage breast cancer than younger women. Biologic as well as chronologic age should be considered in selecting treatments for older women with breast cancer.
      • Women who do not undergo axillary lymph node (ALN) dissection, sentinel lymph node (SLN) biopsy, or ALN irradiation may be at increased risk for ipsilateral lymph node recurrence, especially if they fail to undergo standard adjuvant systemic therapy.
      • Decisions about mammograms for older breast cancer survivors should incorporate discussions with patients about their risk of developing a recurrent or new breast cancer, the potential benefits of mammography in improving outcomes, the potential harms of mammography (including false positives and overdiagnosis/overtreatment), and patients’ values and preferences. Some key points include:
        • Breast cancer survivors continue to have an increased risk of recurrence or new primaries that is higher than the general population (the risk is about 4%–5% over 5 years).
        • Regular mammograms may be helpful in finding these cancers early and improving outcomes, but mammograms also have harms, including false positives, unnecessary biopsies, and finding cancers that never would have become clinically significant in a woman’s lifetime (overdiagnosis).
    • Central Nervous System Cancers (OAO-B, 8 of 32)
      • Postsurgical radiation alone is effective in improving outcomes in patients older than 70 years with glioblastoma, and shorter course regimens are reasonable to consider. Hypofractionated accelerated course RT (with the goal of completing the treatment in 2–3 weeks) is a reasonable treatment option for older patients. Typical fractionation schedules are 34 Gy/10 fractions or 40.05 Gy/15 fractions.       
      • The addition of temozolomide concurrently with radiation therapy followed by at least 6 months of adjuvant temozolomide improves survival in patients between 60 and 70 years of age. There has not been a randomized study between multimodality therapy (RT with concurrent and adjuvant temozolomide) vs. single modality therapy in patients older than 70 years.
      • Hypofractionated accelerated course RT with concurrent and adjuvant temozolomide is safe in older patients, and may have comparable survival and less toxicity to standard fractionated RT with concurrent and adjuvant temozolomide.
    • Hepatocellular Carcinoma (OAO-B 17 of 32)
      • Stereotactic Body Radiation Therapy (SBRT)/Stereotactic Ablative Radiotherapy (SABR) should be considered for older patients, particularly those with comorbidities or compromised performance status, who may not be suitable for liver resection or transplantation. Because it is noninvasive, the successful completion rate of SBRT/SABR is high. Toxicity to treatment can be minimized by careful patient selection, appropriate radiation dosing, and optimized dosimetry to meet normal tissue constraints. Ideal patients are those with good liver function (Child Pugh Class A) and limited volume of disease.
    • Multiple Myeloma (OAO-B 20 of 32)
      • Patients receiving MPL-L had clinically important improvements in more health-related quality-of-life domains than patients treated with MP.
      • Continuous lenalidomide and dexamethasone improves PFS and is associated with superior health-related quality of life compared with MPT.
    • Small Cell Lung Cancer (OAO-B 28 of 32)
      • Prophylactic Cranial Irradiation: Patients 70 years and older with extensive stage and response to chemotherapy may benefit from prophylactic cranial irradiation (PCI), with improved overall survival. Other studies have also suggested a benefit from PCI in patients with limited stage and good response after chemotherapy, without differences in risk reduction by age. However, PCI is associated with more adverse events and increased neurotoxicity in older patients compared to younger patients. PCI is not recommended in patients with poor performance status or impaired neurocognitive functioning.
  • Comprehensive Geriatric Assessment is new to the page. (OAO-C)
    • “Reasons to Perform Comprehensive Geriatric Assessment (CGA)” is new to this section.


For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (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 iPhone, iPad, and Android tablets are now available! Visit

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