NCCN Guidelines® Updates

NCCN Guidelines® Updates

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bone Cancer published in this issue (page 688) include the latest updates. To assist readers interested in noting how the guidelines were updated, highlights of major changes pertaining to the abbreviated version published in this issue are printed below. To view the complete list of updates and full versions of these guidelines, visit the NCCN Web site at

Bone Cancer

Updates in Version 2.2013 of the NCCN Guidelines for Bone Cancer from

Version 1.2012 include:


  • The Chordoma algorithm is new.


  • The Giant Cell Tumor of the Bone algorithm is new.


  • 5th bullet under Workup is new.


  • Under “Adjuvant Treatment”: good and poor response branches include the addition of a new bullet: “Consider additional local therapy (surgical resection ± RT).”

  • Footnote “g” was modified to read: “Response is defined by pathologic mapping per institutional guidelines; the amount of viable tumor is reported as less than 10% of the tumor area in cases showing a good response and greater than or equal to 10% in cases showing a poor response.”


  • Metastatic Disease is a new algorithm.


  • Under “Surveillance”: 6th bullet was modified to include “Orthopedic and Oncologic.”


  • Under “Core Group”: “Musculoskeletal oncologist” was added and “surgical oncologist” was omitted.

  • Under “Specialists Critical in Certain Cases”: “Vascular/general surgeon” was revised and “Neurosurgeon” was added, and “as clinically indicated” was added to last bullet.


  • Under “Biopsy”: 5th bullet was modified to include, “Needle biopsy is not recommended for skull base tumors.”

  • 7th bullet was modified to include “and tissue banking.”

  • 9th bullet is new.

  • Under “Long-Term Follow-up and Surveillance/Survivorship”: 2nd bullet is new.


  • The following regimens were added for chordoma:

    • Imatinib with cisplatin or sirolimus

    • Erlotinib + cetuximab

    • Sunitinib

  • Ewing's Sarcoma:

    • Under “Primary therapy for metastatic disease at initial presentation,” included the acronym “VAdriaC” (vincristine, doxorubicin, and cyclophosphamide).

  • Denosumab, Interferon alfa, and Peginterferon were added for Giant Cell Tumor of Bone.

  • Osteosarcoma: Sorafenib was included as an option for second-line therapy (relapsed/refractory or metastatic disease).

  • New references were added for second-line Ewing's sarcoma, denosumab; interferon alfa and peginterferon; gemcitabine; and sorafenib.


  • Principles of Radiation Therapy is a new section to the guideline.

The goal of the NCCN Guidelines® Updates is to provide readers with important changes that the NCCN Guidelines Panels have incorporated into an algorithm since it was last published. For a more complete detailing of the updated guideline's modifications, please access the NCCN Guidelines® in this issue or, for the complete and most up-to-date version, at

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