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Vanderbilt-Ingram Cancer Center

Chronic myelogenous leukemia (CML) accounts for 15% of adult leukemias. In 2007, an estimated 4500 cases will be diagnosed and 900 patients will die of the disease. The goal of CML therapy is complete remission, which typically progresses from hematologic to cytogenetic remission. These updated 2007 guidelines include changes to several treatment recommendations, including considerations for imatinib dosing, the use of interferon, and management of dasatinib toxicity. Recommendations for hematopoetic stem cell transplantation have also been updated.

For the most recent version of the guidelines, please visit NCCN.org

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Vanderbilt-Ingram Cancer Center

Basal cell and squamous cell skin cancers, collectively known as non-melanoma skin cancers (NMSCS), are the most common skin cancers. More than 1 million cases of NMSC are estimated to be diagnosed each year in the United States and their incidence is rising rapidly. Although rarely metastatic, basal cell and squamous cell cancers can produce substantial local destruction and disfigurement and may involve extensive areas of soft tissue, cartilage, and bone. Updates in the 2007 guidelines include changes to the principles of treatment for both basal cell and squamous cell skin cancers and changes in the consideration of radiotherapy.

For the most recent version of the guidelines, please visit NCCN.org

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Vanderbilt-Ingram Cancer Center

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, low-grade sarcoma of fibroblast origin with an incidence rate of 0.8 cases per million persons each year. Although it rarely metastasizes, initial misdiagnosis, prolonged time to accurate diagnosis, and large tumor size at diagnosis are common. These updated 2007 guidelines include changes in recommendations for considering radiation therapy, as well as those regarding surgical margins in some patients.

For the most recent version of the guidelines, please visit NCCN.org

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Vanderbilt-Ingram Cancer Center

Occult primary tumors, or cancers of unknown primary, account for 5% to 10% of all diagnosed cancers, and are manifested by a wide variety of clinical presentations, while conferring a poor prognosis for most patients. Even after postmortem examination, the primary tumor is not identified in 20% to 50% of patients. Multiple sites of involvement are observed in more than 50% of patients. Although certain patterns of metastases suggest possible primaries, occult primaries can metastasize to any site. In most patients, occult primary tumors are refractory to systemic treatments, and chemotherapy is only palliative and does not significantly improve long-term survival. However, special pathologic studies can identify subsets of patients with tumor types that are more responsive. Treatment options should be individualized for this selected group to achieve improved response and survival rates. Important updates for the NCCN guidelines include the additions of tables on tumor-specific markers and their staining pattern as well as analysis of undifferentiated carcinoma.

For the most recent version of the guidelines, please visit NCCN.org

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Vanderbilt-Ingram Cancer Center

Approximately 13,290 people will be diagnosed with acute myeloid leukemia (AML) in 2008, and 8820 patients will die of the disease. As the population ages, the incidence of AML, along with myelodysplasia, appears to be rising. Clinical trials have led to significant treatment improvements in some areas, primarily acute promyelocytic leukemia. However, recent large clinical trials have highlighted the need for new, innovative strategies, because outcomes for AML patients have not substantially changed in the past 3 decades. The NCCN AML Panel has focused on outlining reasonable treatment options based on recent clinical trials and data from basic science, which may identify new risk factors and treatment approaches. These guidelines attempt to provide a rationale for including several treatment options in some categories, as divergent opinions about the relative risks and benefits of various treatment options have surfaced. Updates for 2009 include new clarifications of some treatment recommendations as well as for defining polymerase chain reaction positivity.

For the most recent version of the guidelines, please visit NCCN.org