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S. Machele Donat

Since the initial report in 2003 of the Intergroup-0080 trial confirming benefit of combined neoadjuvant M-VAC (methotrexate, vinblastine, adriablastine, and cisplatin) chemotherapy and cystectomy in the treatment of muscle-invasive bladder cancer, debate has continued in the literature as to the relative risk/benefits of integrating perioperative chemotherapy into the care of patients, especially in those with organ-confined, muscle-invasive, node-negative disease in whom the benefit may be less. Because of the inaccuracies of clinical staging, the potential morbidity related to M-VAC chemotherapy, a 70% cure rate in pT2No disease with surgery alone, and only a modest (5%) improvement in absolute overall survival with combined therapy, many favor limiting chemotherapy to patients with a pathologic stage of pT3 or greater or node-positive disease. This philosophy was also reflected in the 2008 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bladder Cancer, in which neoadjuvant chemotherapy for clinical T2 disease versus adjuvant therapy based on pathologic risks is only “considered.” Additionally, a recent study looking at the perioperative integration of chemotherapy for stage III bladder cancer in the United States using the National Cancer Data Base showed that only 11.6% of patients underwent any perioperative chemotherapy, with most in the adjuvant setting. These findings indicate that despite randomized trial data showing survival benefit for perioperative chemotherapy, and the current guidelines for therapy supporting those findings, chemotherapy is not being integrated well into the care of patients with muscle-invasive bladder cancer, even in those who, experts agree, have the most potential for benefit.

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Philip Sobash and Nagla Abdel Karim

atypical disease and metastatic disease. Aim of the study is to explore the benefit of adjuvant therapy for thoracic carcinoid tumors. Methods: A literature review was conducted through PubMed in accordance with PRISMA guidelines to identify studies

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of capecitabine + oxaliplatin was added as an option in adjuvant therapy with a category 2A designation. Footnote “j” was clarified by adding “exclusive of those cancers that are MSI-H” to grade 3-4. Surveillance Chest

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Al B. Benson III, Tanios Bekaii-Saab, Emily Chan, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Paul F. Engstrom, Peter C. Enzinger, Marwan G. Fakih, Moon J. Fenton, Charles S. Fuchs, Jean L. Grem, Steven Hunt, Ahmed Kamel, Lucille A. Leong, Edward Lin, Kilian Salerno May, Mary F. Mulcahy, Kate Murphy, Eric Rohren, David P. Ryan, Leonard Saltz, Sunil Sharma, David Shibata, John M. Skibber, William Small Jr, Constantinos T. Sofocleous, Alan P. Venook, Christopher G. Willett, Kristina M. Gregory and Deborah A. Freedman-Cass

rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Adjuvant Therapy for Stage II Disease The panel discussed the impact of adjuvant chemotherapy on

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scientific peer-review process and are overseen by the ORP. An NCCN study funded through the grant mechanism is highlighted below. Randomized Phase II Study Comparing Concise (3 Months) Versus Prolonged (2 Years) Afatinib as Adjuvant Therapy for

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Primary Surgery for Thyroid Cancer Grubbs Elizabeth G. MD Evans Douglas B. MD 07 2007 5 5 6 6 623 623 630 630 0050623 10.6004/jnccn.2007.0053 Role of Radioactive Iodine for Adjuvant Therapy and Treatment of Metastases Jonklaas

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MD 1 2004 2 2 1 1 31 31 41 41 10.6004/jnccn.2004.0002 Melanoma Clinical Practice Guidelines in Oncology 1 2004 2 2 1 1 46 46 46 46 10.6004/jnccn.2004.0003 Point: Interferon-α for Adjuvant Therapy for Melanoma Patients Sabel Michael S

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Tiffany H. Svahn, Joyce C. Niland, Robert W. Carlson, Melissa E. Hughes, Rebecca A. Ottesen, Richard L. Theriault, Stephen B. Edge, Anne F. Schott, Michael A. Bookman and Jane C. Weeks

. 5 Coates AS Keshaviah A Thurlimann B . Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98 . J Clin Oncol 2007 ; 25 : 486

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.2005.0011 Role of New Chemotherapy Agents in Soft Tissue Sarcoma von Mehren Margaret MD 3 2005 3 3 2 2 198 198 205 205 10.6004/jnccn.2005.0012 Adjuvant Therapy for Soft Tissue Sarcoma Schuetze Scott M. * MD, PhD Ray Michael E

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Nora M. Hansen, Sally Anne Scherer and Seema Khan

of 60 cases, care was nonconcordant in 8. Among those cases, 1 patient was advised to have chemotherapy but refused; another patient’s record did not document a recommendation for adjuvant therapy; and 5 patients received treatment but not within the