NCCN临床实践指南_子宫肿瘤(2019.V4)英文版

NCCN org NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Version 4 2019 09 16 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Uterine Neoplasms Version 4 2019 September 16 2019 Continue NCCN Guidelines for Patients available at www nccn org patients Continue NCCN Guidelines Panel Disclosures NCCN Nicole McMillian MS Gynecologic oncology Medical oncology Radiotherapy Radiation oncology Pathology Patient advocacy Internal medicine Discussion Section Writing Committee Peter Frederick MD Roswell Park Cancer Institute David K Gaffney MD PhD Huntsman Cancer Institute at the University of Utah Suzanne George MD Dana Farber Brigham and Women s Cancer Center Robert Giuntoli II MD Abramson Cancer Center at the University of Pennsylvania Ernest Han MD PhD City of Hope National Medical Center Warner K Huh MD O Neal Comprehensive Cancer Center at UAB John R Lurain III MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Andrea Mariani MD Mayo Clinic Cancer Center David Mutch MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Christa Nagel MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Nadeem R Abu Rustum MD Chair Memorial Sloan Kettering Cancer Center Catheryn M Yashar MD Vice Chair UC San Diego Moores Cancer Center Sarah Bean MD Duke Cancer Institute Kristin Bradley MD University of Wisconsin Carbone Cancer Center Susana M Campos MD MPH MS Dana Farber Brigham and Women s Cancer Center Hye Sook Chon MD Moffitt Cancer Center Christina Chu MD Fox Chase Cancer Center David Cohn MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Marta Ann Crispens MD Vanderbilt Ingram Cancer Center Shari Damast MD Yale Cancer Center Smilow Cancer Hospital Oliver Dorigo MD PhD Stanford Cancer Institute Christine M Fisher MD MPH University of Colorado Cancer Center Larissa Nekhlyudov MD MPH Dana Farber Brigham and Women s Cancer Center Amanda Nickles Fader MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Steven W Remmenga MD Fred Preferred Regimens Under Progestational agents clarified Levonorgestrel intrauterine device IUD for select fertility sparing cases Uterine Sarcoma UTSARC A Principles of Pathology This is a new section that includes recommendations for pathologic assessment after total hysterectomy bilateral salpingo oophorectomy and radical hysterectomy UN A Principles of Radiation Therapy for Uterine Neoplasms General Principles Target Volumes Revised the lower common iliacs external iliacs internal iliacs obturators parametria Updates in Version 4 2019 of the NCCN Guidelines for Uterine Neoplasms from Version 3 2019 include Endometrial Carcinoma ENDO D Systemic Therapy for Recurrent Metastatic or High Risk Disease Chemotherapy Regimens Other Recommended Regimens Lenvatinib pembrolizumab category 2B was added as a treatment option New footnote g An FDA approved biosimilar is an appropriate substitute for bevacizumab was added to regimens containing bevacizumab NCCN Guidelines Version 4 2019 Uterine Neoplasms Version 4 2019 09 16 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 9 17 2019 11 47 29 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved UPDATES Initial Evaluation UN 1 Revised Consider liver function test LFT renal function tests chemistry profile Previously this was listed as an optional recommendation New bullet added For elderly patients with uterine cancer see the NCCN Guidelines for Older Adult Oncology Footnote d revised Staged as aggressive Should be treated as a high grade endometrial cancer Endometrial Carcinoma ENDO 1 Second column Medically operable changed to Suitable for primary surgery Also for ENDO 2 Footnote e revised Ovarian preservation may be safe in select premenopausal women with early stage endometrioid cancer Salpingectomy is preferred ENDO 3 Additional Workup First bullet revised Consider CA 125 optional After Additional Workup the pathway decision points were revised to Suitable for primary surgery and Not suitable for primary surgery Previously the following four decision points were listed No evidence of extrauterine disease Ascites including other sites Initially unresectable extrauterine pelvic disease and Distant visceral metastasis ENDO 4 The Surgically staged Stage I adjuvant treatment table was extensively revised Footnote o was revised Potential adverse risk factors age positive lymphovascular invasion tumor size and lower uterine