Interpretation of the development of neoadjuvant therapy for gastric cancer based on the vicissitudes of the NCCN guidelines

Gastric cancer is one of the most common digestive system tumors in China,and locally advanced gastric cancer(LAGC)accounts for a high proportion of newly diagnosed cases.Although surgery is the main treatment for gastric cancer,surgical excision alone cannot achieve satisfactory outcomes in LAGC patients.Neoadjuvant therapy(NAT)has gradually become the standard treatment for patients with LAGC,and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate,but it also significantly improves the long-term prognosis of patients.Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies,and the regimens have also been evolved in the past decades.Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide,here,we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019,and also discuss the future of NAT.

The analysis to the latest changes in NCCN Guidelines of Central Nervous System Cancers about low-grade gliomas and glioblastoma

Gliomas are the most common primary tumors of the central nervous system,around 70 ％ of the malignant brain tumors are gliomas.In the NCCN Guideline Ver.1 2015,the assessment before systemic treatment,treatment principles and prognosis factors of gliomas has significantly changed based on the researches up to date,we try to analyze the reason and the effect of these changes.The most important change is the reintroduction of PCV chemotherapy in systemic treatment,which narrows the gap of prognosis between WHO Ⅱ and Ⅲ gliomas.Other changes including the assessment before systemic treatment,usage of RT and the promotion of evidence level about the Tumor Treating Fields.

Chinese version of NCCN Clinical Practice Guidelines in Oncology officially authorized by NCCN

The publishing conference of the Chinese version of National Comprehensive Cancer Network （NCCN） Clinical Practice Guidelines in Oncology （hereinafter referred to as NCCN Guidelines） and the inaugural peer reviewer meeting of NCCN Clinical Practice Guidelines in Oncology： Digestive System Cancers （hereinafter referred to as NCCN Guidelines on Digestive System Cancers） were held in People＇s Medical Publishing House in January 28^th, 2016 （Figure 1）.

Pathologic and Prognostic Outcomes of Very Low- and Low-Risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy

Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.

The evolving landscape of biliary tract cancers:comparing French and US National Comprehensive Cancer Network guidelines

Biliary tract cancers(BTCs)constitute a heterogeneous group of hepatobiliary malignancies originating along the biliary tree.Approximately up to 20%of primary hepatobiliary tumors consist of BTCs(1).The primary risk factors include cholelithiasis,chronic inflammatory diseases of the bile ducts,non-alcoholic steatohepatitis(NASH),liver cirrhosis,tobacco use,and chronic viral hepatitis B and C infections(2).

The current G-CSF use in cancer patients with chemotherapy

Objective: The purpose of the study was to survey current G-CSF use in cancer patients, investigate whether the use of granulocyte colony-stimulating factor(G-CSF) is standardized. Methods: From July 2012 to October 2012, patients in a third-grade class-A hospital were investigated by self-designed questionnaires, according to ASCO's recommendations for white blood cell growth factors in 2006 and NCCN myeloid growth factors guideline in 2012. Results: Two hundred and twenty-two patients treated with 724 courses of chemotherapy were included. In prophylactic use, 259(35.8%) cases used G-CSF that the guideline doesn't recommend, which belonged to excessive use, the dose were 274 700 μg, accounting for 59.7% of the totle prophylactic use; 105(14.5%) didn't use while the guideline recommend, belonging to lack of use. 89.0% of the prophylactic use were 24–72 h after chemotherapy, only a few(5.4%) on the day of chemotherapy. In therapeutic use, only 3.1% were standardized, with the dose of 23 000 μg, accounting for 7.4% of the total. So 92.6% were excessive. 14.2% of the therapeutic use were 24–72 h after chemotherapy, 21.2% on the day of chemotherapy. Conclusion: More than 50% use of G-CSF weren't standardized, especially the excessive use.