Modification and Implementation of NCCN Guidelines™ on Hepatobiliary Cancers in the Middle East and North Africa Region

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Hepatobiliary Cancers address hepatocellular cancer, cancer of the gallbladder, extrahepatic cholangiocarcinoma, and intrahepatic cholangiocarcinoma. Hepatocellular cancer incidence is higher in the Middle East and North Africa (MENA) region than in the West, and hepatitis B and C infections are particularly important; the incidence of gallbladder cancer is among the highest in the world. Regional problems include delay in diagnosis, shortage of trained staff, and insufficient liver transplant facilities. Furthermore, costs associated with molecular and targeted therapies are an increasing concern. A committee was formed, consisting of leading specialists and decision-makers from the region, with each member being tasked to suggest modifications to the existing guidelines based on review of the literature and consultations with local colleagues. This committee met as a group, and then continued to discuss and debate the suggested modifications electronically. Several recommendations were finalized after vigorous debate. The final approved recommendations were then presented in April 2009 to the chair of the NCCN Hepatobiliary Cancers Panel for onward transmission and approval. This project represents an effort to modify and implement the NCCN Guidelines on Hepatobiliary Cancers in the MENA region, while taking into consideration local differences in patient and disease characteristics. The hope is that this will form the basis of future local, regional, and international cooperation in guideline development and research.

Correspondence: Muhammed Aasim Yusuf, FRCP Edin, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. E-mail: aasim@skm.org.pk
  • 1.

    IbrahimAS. Liver and intrahepatic bile duct cancer. Available at: http://seer.cancer.gov/publications/mecc/mecc_liver.pdf. Accessed March 31 2010.

    • Search Google Scholar
    • Export Citation
  • 2.

    YusufMABadarFMeerzaF. Survival from hepatocellular carcinoma at a cancer hospital in Pakistan. Asian Pac J Cancer Prev2007;8:272274.

    • Search Google Scholar
    • Export Citation
  • 3.

    Kindgom of Saudi Arabia Ministry of Health National Cancer Registry. Cancer incidence report Saudi Arabia 2003. Available at: http://www.kfshrc.edu.sa/oncology/files/NCR2003.pdf. Accessed March 31 2010.

    • Search Google Scholar
    • Export Citation
  • 4.

    CarrBIed.Hepatocellular cancer: diagnosis and treatment. Totowa (NJ): Humana Press; 2005.

  • 5.

    RazaSACliffordGMFranceschiS. Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. Br J Cancer2007;96:11271134.

    • Search Google Scholar
    • Export Citation
  • 6.

    RandiGFranceschiSLa VecchiaC. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer2006;118:15911602.

    • Search Google Scholar
    • Export Citation
  • 7.

    KapoorVKMcMichaelAJ. Gallbladder cancer: an `Indian' disease. Natl Med J India2003;16:209213.

  • 8.

    KhurooMSMahajanRZargarSA. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut1989;30:201205.

    • Search Google Scholar
    • Export Citation
  • 9.

    RandiGMalvezziMLeviF. Epidemiology of biliary tract cancers: an update. Ann Oncol2009;20:146159.

  • 10.

    BruixJShermanM. AASLD practice guideline: management of hepatocellular carcinoma. Hepatology2005;42:12081236.

  • 11.

    LlovetJMFusterJBruixJ. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology1999;30:14341440.

    • Search Google Scholar
    • Export Citation
  • 12.

    BruixJCastellsABoschJ. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology1996;111:10181022.

    • Search Google Scholar
    • Export Citation
  • 13.

    PawlikTMDelmanKAVautheyJN. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl2005;11:10861092.

    • Search Google Scholar
    • Export Citation
  • 14.

    LlovetJMMasXAponteJJ. Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation. Gut2002;50:123128.

    • Search Google Scholar
    • Export Citation
  • 15.

    YaoFYKerlanRKJrHiroseR. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis. Hepatology2008;48:819827.

    • Search Google Scholar
    • Export Citation
  • 16.

    TakadaTAmanoHYasudaH. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreatobiliary carcinoma. Cancer2002;95:16851695.

    • Search Google Scholar
    • Export Citation
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