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Prevention and Treatment of Cancer-Related Infections

Memorial Sloan-Kettering Cancer Center

Infectious diseases are important causes of morbidity and mortality in patients with cancer. In certain instances, the malignancy itself can predispose patients to severe or recurrent infections. Neutropenia has been recognized for many decades as a major risk factor, and effective strategies to anticipate, prevent, and manage infectious complications in patients with cancer experiencing neutropenia have led to improved outcomes. Reflecting the heterogeneity of immunocompromised conditions in patients with cancer and the spectrum of pathogens to which they are susceptible, NCCN expanded the scope of the Fever and Neutropenia Panel in 2007 to create guidelines on Prevention and Treatment of Cancer-Related Infections. These guidelines, newly updated for 2008, characterize major categories of immunologic deficits in persons with cancer and the major pathogens to which they are susceptible.

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Central Nervous System Cancers

Louis Burt Nabors, Mario Ammirati, Philip J. Bierman, Henry Brem, Nicholas Butowski, Marc C. Chamberlain, Lisa M. DeAngelis, Robert A. Fenstermaker, Allan Friedman, Mark R. Gilbert, Deneen Hesser, Matthias Holdhoff, Larry Junck, Ronald Lawson, Jay S. Loeffler, Moshe H. Maor, Paul L. Moots, Tara Morrison, Maciej M. Mrugala, Herbert B. Newton, Jana Portnow, Jeffrey J. Raizer, Lawrence Recht, Dennis C. Shrieve, Allen K. Sills Jr, David Tran, Nam Tran, Frank D. Vrionis, Patrick Y. Wen, Nicole McMillian, and Maria Ho

appropriate. All recommendations are category 2A unless otherwise noted. Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview In

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Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

Sarguni Singh, Megan Eguchi, Sung-Joon Min, and Stacy Fischer

Background Studies have shown a significant correlation between functional status and survival for patients with cancer. 1 – 3 The functional decline associated with progressive cancer is prognostic for health events that severely limit mobility

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NCCN Task Force Report: Breast Cancer in the Older Woman

Robert W. Carlson, Susan Moench, Arti Hurria, Lodovico Balducci, Harold J. Burstein, Lori J. Goldstein, William J. Gradishar, Kevin S. Hughes, Mohammad Jahanzeb, Stuart M. Lichtman, Lawrence B. Marks, Joan S. McClure, Beryl McCormick, Lisle M. Nabell, Lori J. Pierce, Mary Lou Smith, Neal S. Topham, Tiffany A. Traina, John H. Ward, and Eric P. Winer

Overview and Rationale A lthough breast cancer is common in older women, guidance on optimal treatment is limited by their low enrollment in randomized clinical trials. The Surveillance Epidemiology and End Results (SEER) database shows that the

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Ovarian Cancer

The Alvin J. Siteman Cancer Center

Epithelial ovarian cancer is the leading cause of death from gynecologic cancer and the fifth most common cause of cancer mortality in women in the United States. Fewer than 40% of women with ovarian cancer are cured, and 70% of patients present with advanced disease; because of the location of the ovaries, ovarian cancer has been difficult to diagnose at earlier stages. Epidemiologic studies have identified risk factors, including family history. The NCCN guidelines discuss epithelial ovarian cancer as well as less common ovarian histopathologies, including germ cell neoplasms, carcinosarcomas (malignant mixed Müllerian tumors of the ovary), and ovarian stromal tumors. For 2008, updates include the addition of platinum-based combination therapy as a possible treatment modality for recurrence and a listing of preferred agents for acceptable recurrence modalities. New information was also added to the section on clinical presentation.

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Bone Cancer

J. Sybil Biermann, Douglas R. Adkins, Robert S. Benjamin, Brian Brigman, Warren Chow, Ernest U. Conrad III, Deborah A. Frassica, Frank J. Frassica, Suzanne George, Kenneth R. Hande, Francis J. Hornicek, G. Douglas Letson, Joel Mayerson, Sean V. McGarry, Brian McGrath, Carol D. Morris, Richard J. O'Donnell, R. Lor Randall, Victor M. Santana, Robert L. Satcher, Herrick J. Siegel, Neeta Somaiah, and Alan W. Yasko

Bone Cancer NCCN Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus

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Hepatobiliary Cancers

The University of Michigan Comprehensive Cancer Center

Hepatobiliary cancers are common worldwide and highly lethal. Hepatocellular carcinoma is the most common hepatobiliary malignancy and the seventh most common cancer worldwide. Gallbladder cancer is the most common biliary tract malignancy, accounting for approximately 5000 newly diagnosed cases in the United States. Cholangiocarcinomas are diagnosed throughout the biliary tree and are usually classified as intrahepatic or extrahepatic. Intrahepatic cholangiocarcinomas arise from intrahepatic small-duct radicals, whereas extrahepatic cholangiocarcinomas encompass hilar carcinomas (including Klatskin's tumors). These guidelines discuss these subtypes of hepatobiliary cancer and the epidemiology, pathology, etiology, staging, diagnosis, and treatment of each subtype.

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Mortality After Invasive Second Breast Cancers Following Prior Radiotherapy for DCIS

Puyao C. Li, Zilu Zhang, Angel M. Cronin, and Rinaa S. Punglia

Background Women with a history of ductal carcinoma in situ (DCIS) are at increased risk for developing a second breast cancer (SBC) in either the ipsilateral or contralateral breast. 1 , 2 Many women receive breast-conserving surgery (BCS) with

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Challenges With the 8th Edition of the AJCC Cancer Staging Manual for Breast, Testicular, and Head and Neck Cancers

Aysegul A. Sahin, Timothy D. Gilligan, and Jimmy J. Caudell

Breast Cancer Staging “Breast carcinoma is a heterogeneous disease. Classic prognostic and predictive factors for staging include patient age, tumor grade, histologic subtypes, hormone receptor [HR] and HER2 status, vascular invasion, and tumor

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Survival After Definitive Chemoradiotherapy With Concurrent Cisplatin or Carboplatin for Head and Neck Cancer

Michael Xiang, A. Dimitrios Colevas, F. Christopher Holsinger, Quynh-Thu X. Le, and Beth M. Beadle

Background In 2019, an estimated 65,000 cases of head and neck (H&N) cancer will be diagnosed in the United States, with approximately 14,000 cancer-related deaths. 1 Many cases of locally or regionally advanced H&N squamous cell carcinoma (HNSCC