Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology

Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

Extended Lymph Node Sampling During Surgery for Pediatric Renal Tumors Concerning for Malignancy: Balancing Safety and Necessity.

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer focuses on systemic therapy options for the treatment of metastatic colorectal cancer (mCRC), because important updates have recently been made to this section. These updates include recommendations for first-line use of checkpoint inhibitors for mCRC, that is deficient mismatch repair/microsatellite instability-high, recommendations related to the use of biosimilars, and expanded recommendations for biomarker testing. The systemic therapy recommendations now include targeted therapy options for patients with mCRC that is HER2-amplified, or BRAF V600E mutation-positive. Treatment and management of nonmetastatic or resectable/ablatable metastatic disease are discussed in the complete version of the NCCN Guidelines for Colon Cancer available at NCCN.org. Additional topics covered in the complete version include risk assessment, staging, pathology, posttreatment surveillance, and survivorship.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vaginal Cancer outline the recommended diagnostic workup, staging considerations, and treatment options for this rare malignancy. Because vaginal cancer is uncommon and shares many biologic and clinical characteristics with cervical cancer, several management recommendations, particularly systemic therapy, are extrapolated from evidence and practices established for cervical cancer. This guideline excerpt summarizes key components of management, including diagnostic evaluation and workup, principles of staging, pathology considerations, radiation therapy principles, and primary treatment recommendations for both early-stage and advanced disease. It also details approaches to manage relapses, including locoregional recurrence and distant metastases, and provides an in-depth overview of systemic therapy recommendations for vaginal cancer.

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The "Summary of the Guidelines Updates" section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.

National Comprehensive Cancer Network Guidelines: Who Makes Them? What Are They? Why Are They Important?

ASSESSMENT OF TUMOR INVASION OF THE VENA CAVAL WALL IN RENAL CELL CARCINOMA CASES BY MAGNETIC RESONANCE IMAGING

American Gastroenterological Association Technical Review on the Diagnosis and Management of Lynch Syndrome

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

This issue includes the latest version of the NCCN Clinical Practice Guidelines in Oncology on Prostate Cancer, as well as several articles that clarify and expand on themes in those guidelines. For example, the excellent manuscript from Lee and Amling provides the basis for updating the best available nomograms in the 2010 version of the NCCN Guidelines to help provide more individualized recommendations. This need for individualization includes both choice of treatment (active surveillance vs. radical prostatectomy vs. external beam radiation vs. brachytherapy) and type of treatment (need for neurovascular bundle resection and/or pelvic lymph node dissection during radical prostatectomy) for clinically localized prostate cancer or adjuvant or salvage radiation therapy for biochemical recurrence after radical prostatectomy. The review by Nielson, Trock, and Walsh describes the evolution of the Johns Hopkins’ position on salvage or adjuvant radiation therapy. Reanalysis of this experience led to a change from a relatively rare recommendation of additional treatment to the recognition that use of the “Johns Hopkins criteria” for local versus systemic recurrence was denying radiation to many men who might benefit. Finally, Saylor and Smith provide a detailed description of the morbidity associated with androgen deprivation therapy and recommend evidence-based steps that urologists, radiation urologists, and medical oncologists should take in collaboration with primary care physicians to minimize the impact of androgen deprivation therapy on quality of life. These articles expand on 3 of the many changes in the 2010 NCCN Guidelines on Prostate Cancer. Perhaps the most significant change is the recommendation for active surveillance and only active surveillance for men with “low risk” prostate cancer who have a life expectancy less than 10 years. In addition, a new “very low risk” category was created using a modification of the Epstein criteria for clinically insignificant prostate cancer wherein active surveillance is the only recommended option for men whose life expectancy is less than 20 years. These recommendations grow from 2 fundamental factors appreciated by the guideline panel. First, growing evidence suggests that overtreatment of prostate cancer subjects too many men to side effects that outweigh a very small risk of prostate cancer death. This issue was discussed by Klotz 1 in an earlier issue of JNCCN and led to the first major modification of the NCCN Guidelines on Prostate Cancer regarding active surveillance. Second, the continued maturation of experience by many medical centers with large series of men on active surveillance allows better recognition of men for whom risk of death from prostate is very low. The 2010 NCCN Guidelines on Prostate Cancer have been revised substantially. As a consequence, the discussion also has been updated with great care. The Panel recognizes the difficulty of predicting the future of individual patients, but the members feel strongly that continued treatment of all men in whom prostate cancer can be diagnosed is as wrong as denying treatment to every man in whom prostate cancer is diagnosed. Best practice lies between these extremes, and the Panel hopes that both physicians who treat men with prostate cancer and the men and their loved ones who confront a prostate cancer diagnosis will find the 2010 NCCN Clinical Practice Guidelines in Oncology on Prostate Cancer useful.

Focus on kidney cancer

Breast cancer is treated with a multidisciplinary approach involving surgical oncology, radiation oncology, and medical oncology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget's disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of systemic therapy (preoperative and adjuvant) options for nonmetastatic breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.