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NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hepatobiliary Cancers Version 2.2015 NCCN.org Continue Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Panel Members Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion *Al B. Benson, III, MD/Chair † Renuka Iyer, MD Þ † Elin R. Sigurdson, MD, PhD ¶ Robert H. Lurie Comprehensive Cancer Roswell Park Cancer Institute Fox Chase Cancer Center Center of Northwestern University R. Kate Kelley, MD † ‡ Stacey Stein, MD, PhD *Michael I. D’Angelica, MD/Vice-Chair ¶ UCSF Helen Diller Family Yale Cancer Center/Smilow Cancer Hospital Memorial Sloan Kettering Cancer Center Comprehensive Cancer Center G. Gary Tian, MD, PhD † Thomas A. Abrams, MD † Mokenge P. Malafa, MD ¶ St. Jude Children’s Dana-Farber/Brigham and Women’s Moffitt Cancer Center Research Hospital/ Cancer Center The University of Tennessee James O. Park, MD ¶ Health Science Center Fred Hutchinson Cancer Research Center/ Steven R. Alberts, MD, MPH Seattle Cancer Care Alliance Mayo Clinic Cancer Center Jean-Nicolas Vauthey, MD ¶ Timothy Pawlik, MD, MPH, PhD ¶ The University of Texas Chandrakanth Are, MD ¶ The Sidney Kimmel Comprehensive MD Anderson Cancer Center Fred & Pamela Buffett Cancer Center at Cancer Center at Johns Hopkins The Nebraska Medical Center Alan P. Venook, MD † ‡ James A. Posey, MD † UCSF Helen Diller Family Mark Bloomston, MD ¶ University of Alabama at Birmingham Comprehensive Cancer Center The Ohio State University Comprehensive Cancer Center Comprehensive Cancer Center - Rebekah White, MD ¶ James Cancer Hospital and Vaibhav Sahai, MD, MS † Duke Cancer Institute Solove Research Institute University of Michigan ComprehensiveCancer Center Yun Yen, MD, PhD ‡ Daniel Brown, MD † City of Hope Comprehensive Vanderbilt-Ingram Cancer Center Courtney Scaife, MD ¶ Cancer Center Huntsman Cancer Institute Daniel T. Chang, MD § at the University of Utah Andrew X. Zhu, MD, PhD † Stanford Cancer Institute Massachusetts General Hospital Tracey Schefter, MD § Cancer Center University of Colorado Cancer Center Anne M. Covey, MD § Memorial Sloan Kettering Cancer Center Jason K. Sicklick, MD ¶ NCCN UC San Diego Moores Cancer Center Lauren Gallagher, RPh, PhD † Medical oncology Karin G. Hoffmann, RN, CCM § Radiotherapy/Radiation oncology/Interventional radiology Donna Powell, MS, CMD, RT(T) Continue ¶ Surgery/Surgical oncology Jillian Scavone, PhD Þ Internal medicine Sarika Trikha, PharmD ‡ Hematology/Hematology oncology NCCN Guidelines Panel Disclosures *Writing committee member Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Table of Contents Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion NCCN Hepatobiliary Cancers Panel Members Clinical Trials: NCCN believes that Summary of the Guidelines Updates the best management for any cancer patient is in a clinical trial. Participation Hepatocellular Carcinoma (HCC) in clinical trials is especially • HCC Screening (HCC-1) encouraged. • Diagnosis of HCC (HCC-2) • HCC Confirmed, (HCC-4) To find clinical trials online at NCCN • Potentially Resectable or Transplantable, Operable (HCC-5) Member Institutions, click here: • Unresectable (HCC-6) nccn.org/clinical trials/physician.html. • Inoperable, Local Disease, Metastatic Disease, Extensive Liver Tumor Burden (HCC-7) • Child-Pugh Score (HCC-A) NCCN Categories of Evidence and • Principles of Surgery (HCC-B) Consensus: All recommendations • Principles of Locoregional Therapy (HCC-C) are category 2A unless otherwise Gallbladder Cancer specified. • Incidental Finding at Surgery (GALL-1) See NCCN Categories of Evidence • Incidental Finding on Pathologic Review (GALL-2) • Mass on Imaging (GALL-3) and Consensus. • Jaundice (GALL-4) • Metastatic Disease (GALL-4) • Post-Resection (GALL-5) • Principles of Surgery (GALL-A) Intrahepatic Cholangiocarcinoma • Presentation, Workup, Primary Treatment (INTRA-1) • Adjuvant Treatment, Surveillance (INTRA-2) • Principles of Surgery (INTRA-A) Extrahepatic Cholangiocarcinoma • Presentation, Workup, Primary Treatment (EXTRA-1) • Adjuvant Treatment, Surveillance (EXTRA-2) • Principles of Surgery (EXTRA-A) Staging (ST-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2015. Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Updates Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion Summary of the changes in the 2.2015 version of the Guidelines for Hepatobiliary Cancers from the 1.2015 version include: MS-1 • The discussion was updated to reflect the algorithm changes. Updates in Version 1.2015 of the NCCN Guidelines for Hepatobiliary Cancers from Version 2.2014 include: Hepatocellular Carcinoma: HCC-B Principles of Surgery HCC-1 • Sixth bullet; References added to statement: • "Screening": Reference "2" ; "Yao FY, et al. Liver transplantation for "Ultrasound (US)" and "Alfa-fetoprotein (AFP)" statements were hepatocellular carcinoma: expansion of the tumor size limits reversed. does not adversely impact survival. Hepatology 2001:33:1394- "Mass confirmed" revised: "HCC Confirmed HCC (See HCC-4 2)" 1403." added after "Patients meeting the UNOS criteria ([single • Footnote "f" was added: "There is higher-level evidence to support US lesion ≤5 cm, or 2 or 3 lesions ≤3 cm], http://www.unos.org) as a screening tool vs. AFP. See Discussion." should be considered for transplantation (cadaveric or living HCC-5 donation). More controversial are those patients whose tumor • Footnote "r" amended: "Patients with Child-Pugh Class A liver characteristics are marginally outside of the UNOS guidelines function, who fit UNOS criteria (www.unos.org) and are resectable and may be considered at some institutions for living or could be considered for resection or transplant. There is controversy deceased donor for transplantation." over which initial strategy is preferable to treat such patients. These Reference "3"; "Chapman WC, et al. Outcomes of neoadjuvant patients should be evaluated by a multidisciplinary team. transarterial chemoembolization to downstage hepatocellular See Principles of Surgery (HCC-B)" carcinoma before liver transplantation. Ann Surg 2008 HCC-6 Oct;248(4):617-25." added after "Furthermore, patients with tumor • "Not a transplant candidate"; under "Options": Bullet reading characteristics beyond Milan criteria that are down staged to "Locoregional therapy preferred" amended and moved to top. within criteria can also be considered for transplantation." • Footnote "ee" amended: "There are limited data suporting the use of HCC-C (1 of 3) Principles of Locoregional Therapy systemic chemotherapy, and its use in the context of a clinical trial is • Second bullet under "Arterially directed therapies"; acronym "RE" preferred." for "radioembolization" was added. HCC-7 • Third bullet under "Arterially directed therapies"; acronym "RE" • "Treatment"; under "Options" for "Inoperable by performance status added and radioembolization was removed. or comorbidity...": Bullet reading: "Locoregional therapy preferred" HCC-C (2 of 3) Principles of Locoregional Therapy amended and moved to top. • First bullet revised: "All tumors irrespective of the location may be amenable to EBRT (Stereotactic body radiation therapy [SBRT], intensity-modulated radiation therapy [IMRT], or 3D-conformal radiation therapy)." • Fifth bullet added: "Proton beam therapy (PBT) may be appropriate in specific situations." UPDATES Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced
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