American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. Recommendations for the Use of White Blood Cell Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. Preoperative or postoperative therapy for resectable oesophageal cancer: an updated practice guideline. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. Combined modality radiotherapy and chemotherapy in nonsurgical management of localized carcinoma of the esophagus: a practice guideline. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Screening for prostate cancer with prostate-specific antigen testing: American Society of Clinical Oncology Provisional Clinical Opinion. American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. [Approval procedures for clinical trials in the field of radiation oncology]. 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. A prospective observational trial on emesis in radiotherapy: analysis of 1020 patients recruited in 45 Italian radiation oncology centres. Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Early Oral Versus “Traditional” Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intestinal Resection: a Randomized Controlled Trial Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival. Physician exposure to and attitudes toward advertisements for genetic tests for inherited cancer susceptibility Views of American oncologists about the purposes of clinical trials. Implementing a breast cancer registry and treatment plan/summary program in clinical practice: A pilot program Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and  Reduction of Postoperative Complication Rate with the Use of Early Oral Feeding in Gynecologic Oncologic Patients Undergoing a Major Surgery: A Randomized Controlled Trial Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. A cost analysis of hematopoietic colony-stimulating factors. delta 9-tetrahydrocannabinol in clinical oncology. Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Ten-year analysis of the prospective multicentre Chemo-N0 trial validates American Society of Clinical Oncology (ASCO)-recommended biomarkers uPA and PAI-1 for therapy decision making in node-negative breast cancer patients. Partial Gland Ablation for Prostate Cancer: Report of a Food and Drug Administration, American Urological Association, and Society of Urologic Oncology Public Workshop. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. Acupuncture against chemotherapy-induced nausea and vomiting in pediatric oncology
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology . UP DATE METHODOLOGY The Up date Committee completed a review and analysis of data published from 1998 thru February 2006 . The literature review focused on published r and omized controlled trials , and systematic review s and meta-analyses of published phase II and phase III r and omized controlled trials . RECOMMENDATIONS The three-drug combination of a 5-hydroxytryptamine-3 ( 5-HT(3 ) ) serotonin receptor antagonist , dexamethasone , and aprepitant is recommended before chemotherapy of high emetic risk . For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics . These agents should be reserved for patients intolerant of or refractory to 5-HT3 serotonin receptor antagonists , neurokinin-1 receptor antagonists , and dexamethasone . The three-drug combination of a 5-HT3 receptor serotonin antagonist , dexamethasone , and aprepitant is recommended for patients receiving an anthracycline and cyclophosphamide . For patients receiving other chemotherapy of moderate emetic risk , the Up date Committee continues to recommend the two-drug combination of a 5-HT3 receptor serotonin antagonist and dexamethasone . In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis . The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk . CONCLUSION The Up date Committee recommends that clinicians administer antiemetics while considering patients ' emetic risk categories and other characteristics Purpose To up date the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors ( CSFs ) . Methods The American Society of Clinical Oncology convened an Up date Committee and conducted a systematic review of r and omized clinical trials , meta-analyses , and systematic review s from October 2005 through September 2014 . Guideline recommendations were based on the review of the evidence by the Up date Committee . Results Changes to previous recommendations include the addition of tbo-filgrastim and filgrastim-sndz , moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma , and addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high – dose-intensity chemotherapy in urothelial cancer . The Up date Committee did not address recommendations regarding use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults . Recommendations Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20 % or higher and no other equally effective and safe regimen that does not require CSFs is available . Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age , medical history , disease characteristics , and myelotoxicity of the chemotherapy regimen . Dose-dense regimens that require CSFs should only be used within an appropriately design ed clinical trial or if supported by convincing efficacy data . Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy , but not doses high enough to lead to certain death as a result of injury to other organs , include the prompt administration of CSFs . J Clin Oncol 33:3199 - 3212 . © 2015 by American Society of Clinical PURPOSE To provide evidence -based recommendations to practicing oncologists , surgeons , and radiation therapy clinicians to up date the 2005 clinical practice guideline on the use of sentinel node biopsy ( SNB ) for patients with early-stage breast cancer . METHODS The American Society of Clinical Oncology convened an Up date Committee of experts in medical oncology , pathology , radiation oncology , surgical oncology , guideline implementation , and advocacy . A systematic review of the literature was conducted from February 2004 to January 2013 in Medline . Guideline recommendations were based on the review of the evidence by Up date Committee . RESULTS This guideline up date reflects changes in practice since the 2005 guideline . Nine r and omized clinical trials ( RCTs ) met systematic review criteria for clinical questions 1 and 2 ; 13 cohort studies informed clinical question 3 . RECOMMENDATIONS Women without sentinel lymph node ( SLN ) metastases should not receive axillary lymph node dissection ( ALND ) .  Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND ( in most cases ) . Women with SLN metastases who will undergo mastectomy should be offered ALND . These three recommendation are based on RCTs . Women with operable breast cancer and multicentric tumors , with ductal carcinoma in situ ( DCIS ) who will undergo mastectomy , who previously underwent breast and /or axillary surgery , or who received preoperative/neoadjuvant systemic therapy may be offered SNB . Women who have large or locally advanced invasive breast cancer ( tumor size T3/T4 ) , inflammatory breast cancer , or DCIS ( when breast-conserving surgery is planned ) or are pregnant should not undergo SNB . These recommendations are based on cohort studies and /or informal consensus . In some cases , up date d evidence was insufficient to up date previous recommendations Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) . Methods An Up date Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of r and omized controlled trials from January 2007 to February 2014 . Results This guideline up date reflects changes in evidence since the previous guideline . Recommendations There is no cure for patients with stage IV NSCLC . For patients with performance status ( PS ) 0 to 1 ( and appropriate patient cases with PS 2 ) and without an EGFR-sensitizing mutation or ALK gene rearrangement , combination cytotoxic chemotherapy is recommended , guided by histology , with early concurrent palliative care . Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 ( bevacizumab may be added to carboplatin plus paclitaxel if no contraindications ) ; combination or single-agent chemotherapy or palliative care alone for those with PS 2 ; afatinib , erlotinib , or gefitinib for those with sensitizing EGFR mutations ; crizotinib for those with ALK or ROS1 gene rearrangement ; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma . Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens , alternative chemotherapy , or a chemotherapy break . In the second-line setting , recommendations include docetaxel , erlotinib , gefitinib , or pemetrexed for patients with nonsquamous cell carcinoma ; docetaxel , erlotinib , or gefitinib for those with squamous cell carcinoma ; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib . In the third-line setting , for patients who have not received erlotinib or gefitinib , treatment with erlotinib is recommended . There are insufficient data to recommend routine third-line cytotoxic therapy . Decisions regarding systemic therapy should not be made based on age alone . Additional information can be found at http://www.asco.org/ guidelines /nsclc and http://www.asco.org/ guidelines wiki . J Clin Oncol 33:3488 - 3515 . © 2015 by American Society of Clinical PURPOSE To up date the 1999 American Society of Clinical Oncology ( ASCO ) guideline on breast cancer follow-up and management in the adjuvant setting . METHODS An ASCO Expert Panel review ed pertinent information from the literature through March 2006 . More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a r and omized design . RESULTS The evidence supports regular history , physical examination , and mammography as the cornerstone of appropriate breast cancer follow-up . All patients should have a careful history and physical examination performed by a physician experienced in the surveillance of cancer patients and in breast examination . Examinations should be performed every 3 to 6 months for the first 3 years , every 6 to 12 months for years 4 and 5 , and annually thereafter . For those who have undergone breast-conserving surgery , a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy . Thereafter , unless otherwise indicated , a yearly mammographic evaluation should be performed . Patients at high risk for familial breast cancer syndromes should be referred for genetic counseling . The use of CBCs , chemistry panels , bone scans , chest radiographs , liver ultrasounds , computed tomography scans , [18F]fluorodeoxyglucose-positron emission tomography scanning , magnetic resonance imaging , or tumor markers ( carcinoembryonic antigen , CA 15 - 3 , and CA 27.29 ) is not recommended for routine breast cancer follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination . CONCLUSION Careful history taking , physical examination , and regular mammography are recommended for appropriate detection of breast cancer recurrence PURPOSE To up date the 2000 American Society of Clinical Oncology guideline on colorectal cancer surveillance . RECOMMENDATIONS Based on results from three independently reported meta-analyses of r and omized controlled trials that compared low-intensity and high-intensity programs of colorectal cancer surveillance , and on recent analyses of data from major clinical trials in colon and rectal cancer , the Panel recommends annual computed tomography ( CT ) of the chest and abdomen for 3 years after primary therapy for patients who are at higher risk of recurrence and who could be c and i date s for curative-intent surgery ; pelvic CT scan for rectal cancer surveillance , especially for patients with several poor prognostic factors , including those who have not been treated with radiation  ; colonoscopy at 3 years after operative treatment , and , if results are normal , every 5 years thereafter ; flexible proctosigmoidoscopy [ corrected ] every 6 months for 5 years for rectal cancer patients who have not been treated with pelvic radiation  ; history and physical examination every 3 to 6 months for the first 3 years , every 6 months during years 4 and 5 , and subsequently at the discretion of the physician ; and carcinoembryonic antigen every 3 months postoperatively for at least 3 years after diagnosis , if the patient is a c and i date for surgery or systemic therapy .  Chest x-rays , CBCs , and liver function tests are not recommended , and molecular or cellular markers should not influence the surveillance strategy based on available evidence Purpose To up date the Potentially Curable Pancreatic Cancer : American Society of Clinical Oncology Clinical Practice Guideline published on May 31 , 2016 . The October 2016 up date focuses solely on new evidence that pertains to clinical question 4 of the guideline : What is the appropriate adjuvant regimen for patients with pancreatic cancer who have undergone an R0 or R1 resection of their primary tumor ? Methods The recently published results of a r and omized phase III study prompted an up date of this guideline . The high quality of the reported evidence and the potential for its clinical impact prompted the Expert Panel to revise one of the guideline recommendations . Results The ESPAC-4 study , a multicenter , international , open-label r and omized controlled phase III trial of adjuvant combination chemotherapy compared gemcitabine and capecitabine with gemcitabine monotherapy in 730 evaluable patients with resected pancreatic ductal adenocarcinoma .  Median overall survival was improved in the doublet arm to 28.0 months ( 95 % CI , 23.5 to 31.5 months ) versus 25.5 months ( 95 % CI , 22.7 to 27.9 months ) for gemcitabine alone ( hazard ratio , 0.82 ; 95 % CI , 0.68 to 0.98 ; P = .032 ) . Grade 3 and 4 adverse events were similar in both arms , although higher rates of h and -foot syndrome and diarrhea occurred in patients r and omly assigned to the doublet arm . Recommendations All patients with resected pancreatic cancer who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of medical or surgical contraindications . The doublet regimen of gemcitabine and capecitabine is preferred in the absence of concerns for toxicity or tolerance ; alternatively , monotherapy with gemcitabine or fluorouracil plus folinic acid can be offered . Adjuvant treatment should be initiated within 8 weeks of surgical resection , assuming complete recovery . The remaining recommendations from the original 2016 ASCO guideline are unchanged PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer . METHODS American Society of Clinical Oncology convened an Expert Panel of medical oncology , radiation oncology , surgical oncology , gastroenterology , palliative care , and advocacy experts and conducted a systematic review of the literature from January 2002 to June 2015 . Outcomes included overall survival , disease-free survival , progression-free survival , and adverse events . RESULTS Twenty-six r and omized controlled trials met the systematic review criteria . RECOMMENDATIONS A multiphase computed tomography scan of the chest , abdomen , and pelvis should be performed . Baseline performance status and comorbidity profile should be evaluated . The goals of care , patient preferences , psychological status , support systems , and symptoms should guide decisions for treatments . A palliative care referral should occur at first visit . Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile . There is no clear evidence to support one regimen over another . The gemcitabine-based combinations and treatments recommended in the metastatic setting ( eg , fluorouracil , leucovorin , irinotecan , and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel ) have not been evaluated in r and omized controlled trials involving locally advanced , unresectable pancreatic cancer . If there is local disease progression after induction chemotherapy , without metastasis , then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile . If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities , radiation therapy may be offered as an alternative . Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline . Follow-up visits every 3 to 4 months are recommended . Additional information is available at www.asco.org/ guidelines /LAPC and www.asco.org/ guidelines /MetPC and www.asco.org/ guidelines wiki AIMS Oesophageal cancer is an aggressive disease and the optimal therapy for patients with resectable tumours remains unclear . A systematic review and companion practice guideline were published in 2004 ; however , new evidence has become available since the publication of the original report . An up date of the literature search and a revision of the recommendations were undertaken to incorporate the new data . The following research question was addressed : should patients with resectable oesophageal cancer receive preoperative or postoperative therapy together with surgery ? The outcomes of interest were survival , adverse effects and quality of life . MATERIAL S AND METHODS The literature search of the original systematic review was up date d to April 2007 . MEDLINE , EMBASE , Cochrane Library and abstract s from the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were search ed for reports of r and omised controlled trials and meta-analyses comparing preoperative or postoperative therapy with surgery alone or other preoperative or postoperative therapy . After the completion of the draft systematic review and practice guideline , the report was distributed through a mailed survey to 133 health care providers in Ontario for review and feedback . RESULTS The up date d literature search yielded eight new r and omised controlled trial reports and seven new meta- analysis reports for consideration , together with the evidence review ed in the original review publication . Of the 31 practitioners who responded to the mailed survey , 80 % agreed with the draft recommendations as stated , 83 % agreed that the report should be approved as a practice guideline and 86 % indicated that they would probably use the guideline in their own practice . CONCLUSIONS Preoperative cisplatin-based chemotherapy plus radiotherapy is recommended as the preferred modality for the management of surgically resectable patients with oesophageal cancer .  Preoperative cisplatin-based chemotherapy alone is an alternative choice for the management of these patients PURPOSE To develop a guideline to improve the accuracy of immunohistochemical ( IHC ) estrogen receptor ( ER ) and progesterone receptor ( PgR ) testing in breast cancer and the utility of these receptors as predictive markers . METHODS The American Society of Clinical Oncology and the College of American Pathologists convened an international Expert Panel that conducted a systematic review and evaluation of the literature in partnership with Cancer Care Ontario and developed recommendations for optimal IHC ER/PgR testing performance . RESULTS Up to 20 % of current IHC determinations of ER and PgR testing worldwide may be inaccurate ( false negative or false positive ) . Most of the issues with testing have occurred because of variation in preanalytic variables , thresholds for positivity , and interpretation criteria . RECOMMENDATIONS The Panel recommends that ER and PgR status be determined on all invasive breast cancers and breast cancer recurrences . A testing algorithm that relies on accurate , reproducible assay performance is proposed . Elements to reliably reduce assay variation are specified . It is recommended that ER and PgR assays be considered positive if there are at least 1 % positive tumor nuclei in the sample on testing in the presence of expected reactivity of internal ( normal epithelial elements ) and external controls . The absence of benefit from endocrine therapy for women with ER-negative invasive breast cancers has been confirmed in large overviews of r and omized clinical trials Anemia result ing from cancer or its treatment is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin . To address uncertainties regarding indications and efficacy , the American Society of Clinical Oncology and the American Society of Hematology developed an evidence -based clinical practice guideline for the use of epoetin in patients with cancer . The guideline panel found good evidence to recommend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin ( Hgb ) concentration below 10 g/dL. Use of epoetin for patients with less severe anemia ( Hgb level below 12 g/dL but never below 10 g/dL ) should be determined by clinical circumstances . Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly ( 150 U/kg ) for a minimum of 4 weeks . Less strong evidence supports an alternative weekly ( 40 000 U/wk ) dosing regimen , based on common clinical practice . With either administration schedule , dose escalation should be considered for those not responding to the initial dose . In the absence of response , continuing epoetin beyond 6 - 8 weeks does not appear to be beneficial . Epoetin should be titrated once the hemoglobin concentration reaches 12 g/dL. Evidence from one r and omized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodysplasia not receiving chemotherapy ; however , there are no published high- quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy . Therefore , for anemic patients with hematologic malignancies it is recommended that physicians initiate conventional therapy and observe hematologic response before considering use of epoetin OBJECTIVE To determine an effective , evidence -based , postoperative surveillance strategy for the detection and treatment of recurrent breast cancer . Tests are recommended only if they have an impact on the outcomes specified by American Society of Clinical Oncology ( ASCO ) for clinical practice guidelines . POTENTIAL INTERVENTION All tests described in the literature for postoperative monitoring were considered . In addition , the data were critically evaluated to determine the optimal frequency of monitoring . OUTCOME Outcomes of interest include overall and disease-free survival , quality of life , toxicity reduction , and secondarily cost-effectiveness . EVIDENCE A search was performed to determine all relevant articles published over the past 20 years on the efficacy of  surveillance testing for breast cancer recurrence . These publications comprised both retrospective and prospect i ve studies . VALUES Levels of evidence and guideline grade s were rated by a st and ard process . More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a r and omized design . BENEFITS , HARMS , AND COSTS The possible consequences of false-positive and -negative tests were considered in evaluating a preference for one of two tests providing similar information . Cost alone was not a determining factor . RECOMMENDATIONS The attached guidelines and text summarize the up date d recommendations of the ASCO breast cancer expert panel . Data are sufficient to recommend monthly breast self-examination , annual mammography of the preserved and contralateral breast , and a careful history and physical examination every 3 to 6 months for 3 years , then every 6 to 12 months for 2 years , then annually . Data are not sufficient to recommend routine bone scans , chest radiographs , hematologic blood counts , tumor markers ( carcinoembryonic antigen , cancer antigen [ CA ] 15 - 5 , and CA 27.29 ) , liver ultrasonograms , or computed tomography scans . VALIDATION The recommendations of the breast cancer expert panel were evaluated and supported by the ASCO Health Services Research Committee review ers and the ASCO Board of Directors PURPOSE To up date the ASCO clinical practice guideline on adjuvant endocrine therapy on the basis of emerging data on the optimal duration of treatment , particularly adjuvant tamoxifen . METHODS ASCO convened the Up date Committee and conducted a systematic review of r and omized clinical trials from January 2009 to June 2013 and analyzed three historical trials . Guideline recommendations were based on the Up date Committee 's review of the evidence . Outcomes of interest included survival , disease recurrence , and adverse events . RESULTS This guideline up date reflects emerging data on duration of tamoxifen treatment . There have been five studies of tamoxifen treatment beyond 5 years of therapy . The two largest studies with longest reported follow-up show a breast cancer survival advantage with 10-year duration s of tamoxifen use . In addition to modest gains in survival , extended therapy with tamoxifen for 10 years compared with 5 years was associated with lower risks of breast cancer recurrence and contralateral breast cancer . RECOMMENDATIONS Previous ASCO guidelines recommended treatment of women who have hormone receptor-positive breast cancer and are premenopausal with 5 years of tamoxifen , and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor ( in sequence ) . If women are pre- or perimenopausal and have received 5 years of adjuvant tamoxifen , they should be offered 10 years total duration of tamoxifen . If women are postmenopausal and have received 5 years of adjuvant tamoxifen  , they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy PURPOSE To provide current recommendations about the prophylaxis and treatment of venous thromboembolism ( VTE ) in patients with cancer . METHODS PubMed and the Cochrane Library were search ed for r and omized controlled trials , systematic review s , meta-analyses , and clinical practice guidelines from November 2012 through July 2014 . An up date committee review ed the identified abstract s. RESULTS Of the 53 publications identified and review ed , none prompted a change in the 2013 recommendations . RECOMMENDATIONS Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization . Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting . It may be considered for selected high-risk patients . Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and /or dexamethasone should receive prophylaxis with either low-molecular weight heparin ( LMWH ) or low-dose aspirin .  Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days . Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features . LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis ( at least 6 months ) . Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer . Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications . Patients with cancer should be periodically assessed for VTE risk . Oncology professionals should educate patients about the signs and symptoms of VTE PURPOSE To develop a guideline for the use of sentinel node biopsy ( SNB ) in early stage breast cancer . METHODS An American Society of Clinical Oncology ( ASCO ) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early-stage breast cancer . The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB . The guideline was review ed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors . RESULTS The literature review identified one published prospect i ve r and omized controlled trial in which SNB was compared with axillary lymph node dissection ( ALND ) , four limited meta-analyses , and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND ( completion axillary dissection ) . There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer . However , a review of the available evidence demonstrates that , when performed by experienced clinicians , SNB appears to be a safe and acceptably accurate method for identifying early-stage breast cancer without involvement of the axillary lymph nodes . CONCLUSION SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinical ly negative axillary nodes . Completion ALND remains st and ard treatment for patients with axillary metastases identified on SNB . Appropriately identified patients with negative results of SNB , when done under the direction of an experienced surgeon , need not have completion ALND . Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance . Although such specialized techniques are often used , they are not a required part of SLN evaluation for breast cancer at this time . Data suggest that SNB is associated with less morbidity than ALND , but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown PURPOSE To make recommendations regarding combined radiotherapy ( RT ) and chemotherapy ( RTCT ) , compared with RT alone , when a nonsurgical approach is used for patients with localized esophageal carcinoma . MATERIAL S AND METHODS The Medline , Cancerlit , Cochrane Library data bases , and abstract s published in the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology proceedings were search ed for evidence . Evidence was evaluated by two members of the Gastrointestinal Cancer Disease Site Group and method ologists . RESULTS Pooling seven r and omized trials detected a statistically significant survival benefit at 1 year for concomitant RTCT compared with RT alone ( 1-year mortality odds ratio 0.61 ; 95 % confidence interval 0.44 - 0.84 ; p < 0.00001 ) . Local control also significantly improved with concomitant RTCT compared with RT alone for the available data ( odds ratio 0.52 ; 95 % confidence interval 0.31 - 0.89 ; p = 0.004 ) , but a significant increase in adverse effects , including life-threatening toxicities , was shown . CONCLUSIONS Concomitant RT and cisplatin-based CT is recommended over RT alone . Patients should be aware of the increased acute toxicity associated with this approach , and this recommendation should only be made after consideration of the potential risks and benefits and the patient 's general condition . Sequential RTCT is not recommended as st and ard practice PURPOSE This guideline presents evidence -based recommendations for stereotactic body radiation therapy ( SBRT ) in challenging clinical scenarios in early-stage non-small cell lung cancer ( NSCLC ) . METHODS AND MATERIAL S The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing : ( 1 ) application of SBRT to operable patients ; ( 2 ) appropriate use of SBRT in tumors that are central ly located , large , multifocal , or unbiopsied ; ( 3 ) individual tailoring of SBRT in " high-risk " clinical scenarios ; and ( 4 ) SBRT as salvage therapy after recurrence . Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology-approved tools for grading evidence quality and recommendation strength . RESULTS Although few r and omized trials have been completed for SBRT , strong consensus recommendations based on extensive , consistent publications were generated for several questions , including recommendations for fractionation for central tumors and surgery versus SBRT in st and ard-risk medically operable patients with early-stage NSCLC . Lower quality evidence led to conditional recommendations on use of SBRT for tumors > 5 cm , patients with prior pneumonectomy , T3 tumors with chest wall invasion , synchronous multiple primary lung cancer , and as a salvage therapy after prior radiation therapy . These areas of moderate- and low- quality evidence highlight the importance of clinical trial enrollment as well as the role of prospect i ve data registries . CONCLUSIONS SBRT has an important role to play in treating early-stage NSCLC , particularly for medically inoperable patients with limited other treatment options . Shared decision-making with patients should be performed in all cases to ensure the patient underst and s the risks related to SBRT , the side effects , and the alternative treatments available A r and om- sample , anonymous survey of the members of the American Society of Clinical Oncology ( ASCO ) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients . The survey was mailed to about one third ( N = 2,430 ) of all United States-based ASCO members and yielded a response rate of 43 % ( 1,035 ) . More than 44 % of the respondents report recommending the ( illegal ) use of marijuana for the control of emesis to at least one cancer chemotherapy patient . Almost one half ( 48 % ) would prescribe marijuana to some of their patients if it were legal . As a group , respondents considered smoked marijuana to be somewhat more effective than the legally available oral synthetic dronabinol ( [ THC ] Marinol ; Unimed , Somerville , NJ ) and roughly as safe . Of the respondents who expressed an opinion , a majority ( 54 % ) thought marijuana should be available by prescription . These results bear on the question of whether marijuana has a " currently accepted medical use , " at issue in an ongoing administrative and legal dispute concerning whether marijuana in smoked form should be available by prescription along with synthetic THC in oral form . This survey demonstrates that oncologists ' experience with the medical use of marijuana is more extensive , and their opinions of it are more favorable , than the regulatory authorities appear to have believed PURPOSE An American Society of Clinical Oncology ( ASCO ) provisional clinical opinion ( PCO ) offers timely clinical direction to ASCO 's membership following publication or presentation of potentially practice -changing data from major studies . This PCO addresses the integration of palliative care services into st and ard oncology practice at the time a person is diagnosed with metastatic or advanced cancer . CLINICAL CONTEXT Palliative care is frequently misconstrued as synonymous with end-of-life care . Palliative care is focused on the relief of suffering , in all of its dimensions , throughout the course of a patient 's illness . Although the use of hospice and other palliative care services at the end of life has increased , many patients are enrolled in hospice less than 3 weeks before their death , which limits the benefit they may gain from these services . By potentially improving quality of life ( QOL ) , cost of care , and even survival in patients with metastatic cancer , palliative care has increasing relevance for the care of patients with cancer . Until recently , data from r and omized controlled trials ( RCTs ) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving st and ard oncology care have not been available . RECENT DATA Seven published RCTs form the basis of this PCO . PROVISIONAL CLINICAL OPINION Based on strong evidence from a phase III RCT , patients with metastatic non-small-cell lung cancer should be offered concurrent palliative care and st and ard oncologic care at initial diagnosis . While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology setting s , substantial evidence demonstrates that palliative care-when combined with st and ard cancer care or as the main focus of care-leads to better patient and caregiver outcomes . These include improvement in symptoms , QOL , and patient satisfaction , with reduced caregiver burden . Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice , and reduced use of futile intensive care . While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving , no trials to date have demonstrated harm to patients and caregivers , or excessive costs , from early involvement of palliative care . Therefore , it is the Panel 's expert consensus that combined st and ard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and /or high symptom burden . Strategies to optimize concurrent palliative care and st and ard oncology care , with evaluation of its impact on important patient and caregiver outcomes ( eg , QOL , survival , health care services utilization , and costs ) and on society , should be an area of intense research . NOTE ASCO 's provisional clinical opinions ( PCOs ) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and setting s for further research . Because of the rapid flow of scientific information in oncology , new evidence may have emerged since the time a PCO was su bmi tted for publication . PCOs are not continually up date d and may not reflect the most recent evidence . PCOs can not account for individual variation among patients and can not be considered inclusive of all proper methods of care or exclusive of other treatments . It is the responsibility of the treating physician or other health care provider , relying on independent experience and knowledge of the patient , to determine the best course of treatment for the patient . Accordingly , adherence to any PCO is voluntary , with the ultimate determination regarding its application to be made by the physician in light of each patient 's individual circumstances . ASCO PCOs describe the use of procedures and therapies in clinical trials and can not be assumed to apply to the use of these interventions in the context of clinical practice . ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO 's PCOs , or for any errors or omissions PURPOSE An American Society of Clinical Oncology ( ASCO ) provisional clinical opinion ( PCO ) offers timely clinical direction to the ASCO membership after publication or presentation of potentially practice -changing data from major studies . This PCO addresses the role of prostate-specific antigen ( PSA ) testing in the screening of men for prostate cancer . CLINICAL CONTEXT Prostate cancer is the second leading cause of cancer deaths among men in the United States . The rationale for screening men for prostate cancer is the potential to reduce the risk of death through early detection . RECENT DATA Evidence from a 2011 Agency for Healthcare Research and Quality systematic review primarily informs this PCO on the benefits and harms of PSA-based screening . An up date search was conducted to March 16 , 2012 , for additional evidence related to the topic . RESULTS In one r and omized trial ,  PSA testing in men who would not otherwise have been screened result ed in reduced death rates from prostate cancer , but it is uncertain whether the size of the effect was worth the harms associated with screening and subsequent unnecessary treatment . Although there are limitations to the existing data , there is evidence to suggest that men with longer life expectancy may benefit from PSA testing . Adverse events associated with prostate biopsy are low for the majority of men ; however , several population -based studies have shown increasing rates of infectious complications after prostate biopsy , which is a concern PURPOSE To up date a clinical practice guideline on the use of chemotherapy and radiation therapy protectants for patients with cancer . METHODS An up date committee review ed literature published since the last guideline up date in 2002 . RESULTS Thirty-nine reports met the inclusion criteria : palifermin and dexrazoxane , three reports ( two studies ) each ; amifostine , 33 reports ( 31 studies ) ; and mesna , no published r and omized trials identified since 2002 . RECOMMENDATIONS Dexrazoxane is not recommended for routine use in breast cancer ( BC ) in adjuvant setting , or metastatic setting with initial doxorubicin-based chemotherapy . Consider use with metastatic BC and other malignancies , for patients who have received more than 300 mg/m(2 ) doxorubicin  who may benefit from continued doxorubicin-containing therapy . Cardiac monitoring should continue in patients receiving doxorubicin . Amifostine may be considered for prevention of cisplatin-associated nephrotoxicity , reduction of grade 3 to 4 neutropenia ( alternative strategies are reasonable ) , and to decrease acute and late xerostomia with fractionated radiation therapy alone for head and neck cancer . It is not recommended for protection against thrombocytopenia , prevention of platinum-associated neurotoxicity or ototoxicity or paclitaxel-associated neuropathy , prevention of radiation therapy-associated mucositis in head and neck cancer , or prevention of esophagitis during concurrent chemoradiotherapy for non-small-cell lung cancer . Palifermin is recommended to decrease severe mucositis in autologous stem-cell transplantation ( SCT ) for hematologic malignancies with total-body irradiation ( TBI ) conditioning regimens , and considered for patients undergoing myeloablative allogeneic SCT with TBI-based conditioning regimens . Data are insufficient to recommend use in the non-SCT setting Purpose To provide current recommendations on the use of sentinel node biopsy ( SNB ) for patients with early-stage breast cancer . Methods PubMed and the Cochrane Library were search ed for r and omized controlled trials , systematic review s , meta-analyses , and clinical practice guidelines from 2012 through July 2016 . An Up date Panel review ed the identified abstract s. Results Of the eight publications identified and review ed , none prompted a change in the 2014 recommendations , which are reaffirmed by the up date d literature review . Conclusion Women without sentinel lymph node ( SLN ) metastases should not receive axillary lymph node dissection ( ALND ) . Women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND ( in most cases ) . Women with SLN metastases who will undergo mastectomy should be offered ALND . These three recommendations are based on r and omized controlled trials . Women with operable breast cancer and multicentric tumors , with ductal carcinoma in situ , who will undergo mastectomy , who previously underwent breast and /or axillary surgery , or who received preoperative/neoadjuvant systemic therapy may be offered SNB .  Women who have large or locally advanced invasive breast cancer ( tumor size T3/T4 ) , inflammatory breast cancer , or ductal carcinoma in situ ( when breast-conserving surgery is planned ) or are pregnant should not undergo SNB BACKGROUND AND PURPOSE Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection ( Bundesamt für Strahlenschutz , BfS ) . For studies in the field of radiation oncology , differentiation between use of radiation for " medical care ( Heilkunde ) " versus " medical research " frequently leads to contradictions . The aim of this article is to provide principle investigators , individuals , and institutions involved in the process , as well as institutional review or ethics committees , with the necessary information for this assessment . Information on the legal frame and the approval procedures are also provided . METHODS A workshop was co-organized by the German Society for Radiation Oncology ( DEGRO ) , the Working Party for Radiation Oncology ( ARO ) of the German Cancer Society ( DKG ) , the German Society for Medical Physics ( DGMP ) , and the German Cancer Consortium ( DKTK ) in October 2013 . This paper summarizes the results of the workshop and the follow-up discussion s between the organizers and the BfS. RESULTS Differentiating between " Heilkunde " which does not need to be approved by the BfS and " medical research " is whether the specific application of radiation ( beam quality , dose , schedule , target volume , etc . ) is a clinical ly established and recognized procedure . This must be answered by the qualified physician(s ) ( " fachkundiger Arzt " according to German radiation protection law ) in charge of the study and the treatments of the patients within the study , taking into consideration of the best available evidence from clinical studies , guidelines and consensus papers . Among the important parameters for assessment are indication , total dose , and fractionation . Radiation treatments applied outside clinical trials do not require approval by the BfS , even if they are applied within a r and omized or nonr and omized clinical trial . The decision-making by the " fachkundigem Arzt " may be supported on request by an opinion given by the DEGRO Expert Committee for clinical trials . CONCLUSION An important aim for promoting clinical research and patient care in radiation oncology is to further professionalize planning and implementation of clinical trials in this field . Correct assessment , at an early stage , whether a trial needs to be approved by the BfS may reduce unnecessary costs and reduce the time needed for the approval procedure for those trials which need to be assessed by the PURPOSE To perform a r and omized trial comparing 70 and 80 Gy radiotherapy for prostate cancer . PATIENTS AND METHODS A total of 306 patients with localized prostate cancer were r and omized . No and rogen deprivation was allowed . The primary endpoint was biochemical relapse according to the modified 1997-American Society for Therapeutic Radiology and Oncology and Phoenix definitions . Toxicity was grade d using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective , objective , management , analytic scales ( LENT-SOMA ) scales . The patients ' quality of life was scored using the European Organization for Research and Treatment of Cancer Quality of Life Question  naire 30-item cancer-specific and 25-item prostate-specific modules . RESULTS The median follow-up was 61 months . According to the 1997-American Society for Therapeutic Radiology and Oncology definition , the 5-year biochemical relapse rate was 39 % and 28 % in the 70- and 80-Gy arms , respectively ( p = .036 ) . Using the Phoenix definition , the 5-year biochemical relapse rate was 32 % and 23.5 % , respectively ( p = .09 ) . The subgroup analysis showed a better biochemical outcome for the higher dose group with an initial prostate-specific antigen level > 15 ng/mL. At the last follow-up date , 26 patients had died , 10 of their disease and none of toxicity , with no differences between the two arms . According to the Radiation Therapy Oncology Group scale , the Grade 2 or greater rectal toxicity rate was 14 % and 19.5 % for the 70- and 80-Gy arms ( p = .22 ) , respectively . The Grade 2 or greater urinary toxicity was 10 % at 70 Gy and 17.5 % at 80 Gy ( p = .046 ) . Similar results were observed using the LENT-SOMA scale . Bladder toxicity was more frequent at 80 Gy than at 70 Gy ( p = .039 ) . The quality -of-life question naire results before and 5 years after treatment were available for 103 patients with no differences found between the 70- and 80-Gy arms . CONCLUSION High-dose radiotherapy provided a better 5-year biochemical outcome with slightly greater toxicity The purpose of this article is to provide up date d recommendations for the treatment of patients with stage IV non-small-cell lung cancer . A literature search identified relevant r and omized trials published since 2002 . The scope of the guideline was narrowed to chemotherapy and biologic therapy . An Up date Committee review ed the literature and made up date d recommendations . One hundred sixty-two publications met the inclusion criteria . Recommendations were based on treatment strategies that improve overall survival . Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life . For first-line therapy in patients with performance status of 0 or 1 , a platinum-based two-drug combination of cytotoxic drugs is recommended . Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy . For patients with performance status of 2 , a single cytotoxic drug is sufficient . Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment . Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy . The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor ( EGFR ) mutation ; for negative or unknown EGFR mutation status , cytotoxic chemotherapy is preferred . Bevacizumab is recommended with carboplatin-paclitaxel , except for patients with certain clinical characteristics . Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry . Docetaxel , erlotinib , gefitinib , or pemetrexed is recommended as second-line therapy . Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib . Data are insufficient to recommend the routine third-line use of cytotoxic drugs . Data are insufficient to recommend routine use of molecular markers to select chemotherapy PURPOSE A prospect i ve observational multicentre trial was carried out to assess the incidence , pattern , and prognostic factors of  radiation-induced emesis ( RIE )  , and to evaluate the use of antiemetic drugs  in patients treated with radiotherapy or concomitant radio-chemotherapy .  The application in clinical practice of the Multinational Association of Supportive Care in Cancer guidelines was also studied . MATERIAL S AND METHODS Forty-five Italian radiation oncology centres took part in this trial . The accrual lasted for 3 consecutive weeks and only patients starting radiotherapy or concomitant radio-chemotherapy in this period were enrolled . Evaluation was based on diary card filled in daily by patients during treatment and one week after stopping it . Diary card recorded the intensity of nausea/vomiting and prophylactic/symptomatic antiemetic drug prescriptions .  RESULTS A total of 1020 patients entered into the trial , and 1004 were evaluable .  Vomiting and nausea occurred in 11.0 % and 27.1 % of patients , respectively , and 27.9 % patients had both vomiting and nausea . In multifactorial analysis , the only statistically significant patient-related risk factors were concomitant chemotherapy and previous experience of vomiting induced by chemotherapy . Moreover , two radiotherapy-related factors were significant risk factors for RIE , the irradiated site ( upper abdomen ) and field size ( > 400 cm(2 ) ) . An  antiemetic drug  was given only to a minority ( 17 % ) of patients receiving RT , and the prescriptions were prophylactic in 12.4 % and symptomatic in 4.6 % . Different compounds and a wide range of doses and schedules were used . CONCLUSIONS These data were similar to those registered in our previous observational trial , and the radiation oncologists ' attitude in underestimating RIE and under prescribing antiemetics was confirmed PURPOSE To up date the analysis of the Dutch dose-escalation trial of radiotherapy for prostate cancer . PATIENTS AND METHODS A total of 669 patients with localized prostate cancer were r and omly assigned to receive  68 or 78 Gy . The patients were stratified by age , institution , use of neoadjuvant or adjuvant hormonal therapy , and treatment group . The primary endpoint was freedom from failure ( FFF ) , with failure defined as clinical or biochemical failure . Two definitions of biochemical failure were used : the American Society for Therapeutic Radiology and Oncology definition ( three consecutive increases in prostate-specific antigen level ) and the Phoenix definition ( nadir plus 2 microe secondary endpoints were freedom from clinical failure , overall survival , and genitourinary and gastrointestinal toxicity . RESULTS After a median follow-up of 70 months , the FFF using the American Society for Therapeutic Radiology and Oncology definition was significantly better in the 78-Gy arm than in the 68-Gy arm ( 7-year FFF rate , 54 % vs. 47 % , respectively ; p = 0.04 ) . The FFF using the Phoenix definition was also significantly better in the 78-Gy arm than in the 68-Gy arm ( 7-year FFF rate , 56 % vs. 45 % , respectively ; p = 0.03 ) . However , no differences in freedom from clinical failure or overall survival were observed . The incidence of late Grade 2 or greater genitourinary toxicity was similar in both arms ( 40 % and 41 % at 7 years ; p = 0.6 ) . However , the cumulative incidence of late Grade 2 or greater gastrointestinal toxicity was increased in the 78-Gy arm compared with the 68-Gy arm ( 35 % vs. 25 % at 7 years ; p = 0.04 ) . CONCLUSION The results of our study have shown a statistically significant improvement in FFF in prostate cancer patients treated with 78 Gy but with a greater rate of late gastrointestinal toxicity Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing laparotomy with associated intestinal resection . Methods Patients aged 18–75 years , undergoing elective laparotomy , and with preoperative diagnosis of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists ( ASA ) score ≥4 , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1st , 2007 and March 15th , 2008 , 40 patients were r and omized to receive either EOF or TOF  . Hospital stay in patients who received EOF ( n = 18 ) was 6.9 days versus 9.1 days in the TOF group ( n = 22 ) ( P = 0.022 ) . Requirements for analgesic and antiemetic drugs , intensity of pain , intestinal function recovery , mean levels of postoperative satisfaction , postoperative complications , and quality -of-life scores did not differ between the two groups . Conclusion Early resumption of oral intake is feasible and safe in gynecologic oncology patients undergoing intestinal resection as part of a planned surgical procedure . Moreover , significant reduction in length of hospital stay was demonstrated Purpose To increase awareness , outline strategies , and offer guidance on the recommended management of immune-related adverse events in patients treated with immune checkpoint inhibitor ( ICPi ) therapy .  Methods A multidisciplinary , multi-organizational panel of experts in medical oncology , dermatology , gastroenterology , rheumatology , pulmonology , endocrinology , urology , neurology , hematology , emergency medicine , nursing , trialist , and advocacy was convened to develop the clinical practice guideline . Guideline development involved a systematic review of the literature and an informal consensus process . The systematic review focused on guidelines , systematic review s and meta-analyses , r and omized controlled trials , and case series published from 2000 through 2017 . Results The systematic review identified 204 eligible publications . Much of the evidence consisted of systematic review s of observational data , consensus guidelines , case series , and case reports . Due to the paucity of high- quality evidence on management of immune-related adverse events , recommendations are based on expert consensus . Recommendations Recommendations for specific organ system-based toxicity diagnosis and management are presented . While management varies according to organ system affected , in general , ICPi therapy should be continued with close monitoring for grade 1 toxicities , with the exception of some neurologic , hematologic , and cardiac toxicities .  ICPi therapy may be suspended for most grade 2 toxicities , with consideration of resuming when symptoms revert to grade 1 or less . Corticosteroids may be administered . Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids ( prednisone 1 to 2 mg/kg/d or methylprednisolone 1 to 2 mg/kg/d ) . Corticosteroids should be tapered over the course of at least 4 to 6 weeks . Some refractory cases may require infliximab or other immunosuppressive therapy . In general , permanent discontinuation of ICPis is recommended with grade 4 toxicities , with the exception of endocrinopathies that have been controlled by hormone replacement . Additional information is available at www.asco.org/supportive-care- guidelines and www.asco.org/ guidelines wiki PURPOSE Nowadays , advanced irradiation techniques make it possible to escalate safely the dose in prostate cancer . We studied the effect of a higher dose on tumor control in a r and omized trial with a median follow-up of 110 months . PATIENTS AND METHODS Patients with T1b-T4N0 prostate cancer ( n=664 ) were r and omized between 78 Gy and 68 Gy . Primary endpoint was biochemical and /or clinical failure ( BCF ) according to the American Society for Therapeutic Radiology and Oncology ( ASTRO ) guidelines ( 3 consecutive rises ) , and to Phoenix ( nadir plus 2 μg/L ) . Secondary endpoints were clinical failure ( CF ) , local failure ( LF ) , prostate cancer death ( PCD ) , and overall survival ( OS ) . Explorative subgroup analyses were performed . RESULTS BCF rate ( HR=0.8 ; 20 % less events ) and LF rate ( HR=0.5 ; 50 % less events ) were significantly lower in the 78 Gy arm ( p<0.05 ) . CF , PCD and OS were similar in both arms . A significant heterogeneity of treatment effect was found for PSA cutoffs between 7 and 10 μg/L. CONCLUSION We observed significantly less BCF and LF in the high-dose arm . This suggests improvement of the therapeutic ratio . However , we observed similar rates of CF and PCD at the current up date . More follow-up is needed to investigate which patients benefit in terms of prolonged OS Commercial marketing material s may serve as a source of information for physicians about genetic testing for inherited cancer susceptibility ( GTICS ) in addition to medical guidelines , continuing education , and journal articles . The primary purpose s of this study were to : ( 1 ) determine the percentage of physicians who received advertisements for GTICS early in the diffusion of commercial GTICS ( 1999–2000 ) ; ( 2 ) assess associated characteristics ; and ( 3 ) measure the perceived importance of commercial advertisements  and promotions in physicians ' decisions to recommend testing to patients . A nationally representative , stratified r and om sample of 1,251 physicians from the American Medical Association ( AMA ) Physician Masterfile completed a 15–20 min mixed mode question naire that assessed specialty , previous use of genetic tests , practice characteristics , age , and receipt of advertising material s ( response rate = 71 % ) . Overall , 27.4 % ( n = 426 ) had received advertisements . In multivariate analysis , factors associated with receipt of advertisements included : specialties in obstetrics/gynecology , oncology , or gastroenterology ; past GTICS use , and age 50 + . One of four felt that advertisements would be important in their decision to recommend GTICS . Study results indicate that physicians , particularly in oncology , obstetrics/gynecology , and gastroenterology , began receiving  GTICS advertisements commensurate with the early diffusion of commercially available tests into clinical practice . At that time , one‐quarter of the physicians considered advertisements to play an important role in their clinical decision making , suggesting attention to other sources of information and additional factors . Published 2005 Wiley‐Liss , BACKGROUND Many research subjects believe incorrectly that the primary purpose of clinical trials is to benefit the participants rather than to improve therapy for future patients . However , few data are available about how physicians view trials . METHODS We mailed surveys to a stratified r and om sample ( n = 1120 ) of U.S. medical , pediatric , and other oncology specialists who were selected from the American Society of Clinical Oncology Membership Directory . Respondents were asked to select , from a list of options , their reasons for enrolling individual patients in trials  and what they thought the main societal purpose s of clinical trials are . We used logistic regression models to evaluate which demographic and clinical practice characteristics were associated with responses to these questions . All statistical tests were two-sided . RESULTS Of the 547 physicians ( 48.8 % ) who responded , 40.5 % of the medical oncologists , 32.3 % of the pediatric oncologists , and 62.6 % of the other oncology subspecialists reported enrolling individual patients in clinical trials to improve future therapy . Most of the other respondents reported enrolling patients to ensure that they received state-of-the-art treatment . When asked about the main societal purpose of clinical trials , 72.7 % of the medical oncologists , 59.4 % of the pediatric oncologists , and 81.9 % of the other oncology subspecialists cited  improving future therapy ;  most of the other respondents cited ensuring state-of-the-art treatment for participants . In multivariable analysis , medical oncologists ( odds ratio [ OR ] = 0.6 , 95 % confidence interval [ CI ] = 0.3 to 0.9 ) and pediatric oncologists ( OR = 0.3 , 95 % CI = 0.2 to 0.5 ) were less likely than other oncologists to identify improving future therapy as the main societal purpose of clinical trials , whereas industry physicians ( OR = 4.6 , 95 % CI = 1.1 to 20.5 ) chose this option more often than physicians who did not work for industry . CONCLUSIONS Many respondents viewed the main societal purpose of clinical trials as benefiting the participants rather than as creating generalizable knowledge to advance future therapy . This view , which was more prevalent among specialists such as pediatric oncologists that enrolled greater proportions of patients in trials , conflicts with established principles of research ethics There is a need to better measure and improve the quality of oncology care and improve communication with patients and other providers . The American Society of Clinical Oncology Breast Cancer Registry ( BCR ) pilot evaluated the feasibility and acceptability of prospect i ve data collection for quality assessment in daily clinical practice . Data were used to create and share treatment plans/summaries ( TPSs ) at the point of care Purpose Provide evidence -based recommendations updating the 2015 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer ( NSCLC ) . Methods The ASCO NSCLC Expert Panel made recommendations based on a systematic review of r and omized controlled trials from February 2014 to December 2016 plus the Cancer Care Ontario Program in Evidence -Based Care 's up date of a previous ASCO search . Results This guideline up date reflects changes in evidence since the previous guideline up date . Fourteen r and omized controlled trials provide the evidence base ; earlier phase trials also informed recommendation development . Recommendations New or revised recommendations include the following . Regarding first-line treatment for patients with non-squamous cell carcinoma or squamous cell carcinoma ( without positive markers , eg , EGFR/ALK /ROS1 ) , if the patient has high programmed death lig and 1 ( PD-L1 ) expression , pembrolizumab should be used alone ; if the patient has low PD-L1 expression , clinicians should offer st and ard chemotherapy . All other clinical scenarios follow 2015 recommendations . Regarding second-line treatment in patients who received first-line chemotherapy  , without prior immune checkpoint therapy , if NSCLC tumor is positive for PD-L1 expression , clinicians should use single-agent nivolumab , pembrolizumab , or atezolizumab ; if tumor has negative or unknown PD-L1 expression , clinicians should use nivolumab or atezolizumab . All immune checkpoint therapy is recommended alone plus in the absence of contraindications . For patients who received a prior first-line immune checkpoint inhibitor , clinicians should offer st and ard chemotherapy . For patients who can not receive immune checkpoint inhibitor after chemotherapy , docetaxel is recommended ; in patients with nonsquamous NSCLC , pemetrexed is recommended . In patients with a sensitizing EGFR mutation , disease progression after first-line epidermal growth factor receptor tyrosine kinase inhibitor therapy , and T790 M mutation , osimertinib is recommended ; if NSCLC lacks the T790 M mutation , then chemotherapy is recommended . Patients with ROS1 gene rearrangement without prior crizotinib may be offered crizotinib , or if they previously received crizotinib , they may be offered chemotherapy Abstract . There is a considerable gap between obtaining results in r and omized trials and implementing them into practice . This is particularly relevant with the high-cost 5HT3 antiemetics , which include ondansetron , dolasetron and granisetron . R and omized trial data suggests that they should be used as a single daily dose during only the first 24 h of chemotherapy because they offer little benefit over less costly agents beyond this period . In this study , six intervention methods ( i.e. multifaceted approach ) were combined to change physicians ' 5HT3 prescribing patterns to comply with evidence -based antiemetic guidelines . A six-step implementation process was adopted , consisting of guideline dissemination , the use of opinion leaders , interactive educational workshops , therapeutic reminders in the form of preprinted orders , clinical interventions by pharmacists for the event of inappropriate antiemetic orders , and physician audit and feedback . Once implemented , the control of emesis was collected in all patients who were enrolled in the intervention program . Multivariable regression analysis was then used to assess whether prescribing within antiemetic guidelines compromised patient care . A total of 195 in patients were enrolled in the study over the 4-month intervention period . Overall , 88.7 % of granisetron prescriptions fulfilled the guidelines with respect to appropriate indication , dosage , and duration of therapy . The multivariable analysis suggested that granisetron prescribing within guidelines did not compromise the control of acute and delayed emesis . In addition , patients who received evidence -based antiemetic therapy experienced a significant reduction in the severity of acute nausea [ risk ratio ( RR ) = 0.69 ; P=0.03 ] . The results of this guideline implementation study revealed that a pharmacist-driven multifaceted intervention program for such high-cost agents as 5HT3 antiemetics can promote their use in a clinical ly appropriate manner and can save unnecessary drug costs without compromising the quality of patient care Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment , decrease quality of life , or impact the actual survival of the patient with cancer . The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers . Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review ( 1996 to 2016 ) of meta-analyses , r and omized clinical trials , observational studies , and clinical experience . Study quality was assessed using established methods , per study design . The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology . Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations . The strength of the recommendations in these guidelines is based on the quality , amount , and consistency of the evidence and the balance between benefits and harms . Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy . Certain higher risk population s of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies . Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy . For certain higher risk survivors of cancer , routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy , so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction This document revises and up date s the original “ Guidelines for Coronary Angiography  , ” published in 1987 . This executive summary and recommendations appears in the May 4 , 1999 , issue of Circulation . The guidelines in their entirety , including the American College of Cardiology/American Heart Association ( ACC/AHA ) class I , II , and III recommendations , are published in the May 1999 issue of the Journal of the American College of Cardiology . Reprints of both the full text and executive summary and recommendations are available from both organizations . The frequent and still growing use of coronary angiography , its relatively high costs , its inherent risks , and the ongoing evolution of its indications provide the reasons for this revision . The committee appointed to develop this document included private practitioners and academicians who were selected to represent both experts in coronary angiography and senior clinician consultants . Representatives from the family practice and internal medicine professions were also included on the committee . In addition to review ing the original document , the committee conducted a search of the literature for the 10 years preceding development of these guidelines . Evidence was compiled and ranked by the committee . Whereas r and omized trials are often available for reference in the development of treatment guidelines , r and omized trials regarding the use of diagnostic procedures such as coronary angiography are rarely available . This document uses the ACC/AHA classifications of class I , II , and III . These classes summarize the indications for coronary angiography as follows : Class I : Conditions for which there is evidence and /or general agreement that this procedure is useful and effective . Class II : Conditions for which there is conflicting evidence and /or a divergence of opinion about the usefulness/efficacy of performing the procedure . Class IIa : Weight of evidence /opinion is in favor of usefulness/ efficacy . Class IIb : Usefulness/efficacy is less well established by evidence /opinion . Class III : Conditions for which there Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing a complex laparotomy , including upper abdominal surgery . Methods Patients aged 18–75 years , undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists score ≥4 , intestinal resection , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1 , 2007 , and November 17 , 2007 , a total of 143 patients were r and omized to receive either EOF or TOF . Hospital stay for patients who received EOF ( n = 71 ) was 4.7 vs. 5.8 days for the TOF group ( n = 72 ) ( P = 0.006 ) . The mean level of postoperative satisfaction was significantly higher in the EOF group ( 82.8 vs. 71.7 mm , P ≤ 0.001 ) . Patients who received the TOF scheme had significantly higher overall postoperative complications ( 39 vs. 17 % in EOF group , P = 0.003 ) and infective complications ( 14 % in TOF group vs. 3 % in EOF group , P = 0.017 ) . Variables such as nausea and vomiting , analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups . Conclusions On the basis of these findings , the policy of EOF should be used after a complex gynecologic oncologic laparotomy IMPORTANCE Although many patients with end-stage cancer are offered chemotherapy to improve quality of life ( QOL ) , the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied . American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status . OBJECTIVE To evaluate the association between chemotherapy use and QOL near death ( QOD ) as a function of patients ' performance status . DESIGN , SETTING , AND PARTICIPANTS A multi-institutional , longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008 . Chemotherapy use ( n = 158 [ 50.6 % ] ) and Eastern Cooperative Oncology Group ( ECOG ) performance status were assessed at baseline ( median = 3.8 months before death ) and patients with progressive metastatic cancer ( N = 312 ) following at least 1 chemotherapy regimen  were followed prospect ively until death at 6 outpatient oncology clinics in the United States . MAIN OUTCOMES AND MEASURES Patient QOD was determined using vali date d caregiver ratings of patients ' physical and mental distress in their final week . RESULTS Chemotherapy use was not associated with patient survival controlling for clinical setting and patients ' performance status . Among patients with good ( ECOG score = 1 ) baseline performance status , chemotherapy use compared with nonuse was associated with worse QOD ( odds ratio [ OR ] , 0.35 ; 95 % CI , 0.17 - 0.75 ; P = .01 ) . Baseline chemotherapy use was not associated with QOD among patients with moderate ( ECOG score = 2 ) baseline performance status ( OR , 1.06 ; 95 % CI , 0.51 - 2.21 ; P = .87 ) or poor ( ECOG score = 3 ) baseline performance status ( OR , 1.34 ; 95 % CI , 0.46 - 3.89 ; P = .59 ) . CONCLUSIONS AND RELEVANCE Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer , its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status . The QOD in patients with end-stage cancer is not improved , and can be harmed , by chemotherapy use near death , even in patients with good performance status The administration of hematopoietic colony-stimulating factors ( CSFs ) to reduce the severity and duration of neutropenia associated with systemic chemotherapy has become widespread , although the appropriate use of these agents has not yet been fully defined . A cost model based on decision theory is presented for three therapeutic choices in these patients : no CSF , prophylactic CSF , and therapeutic CSF . Baseline probabilities were derived from a prospect i ve , r and omized , placebo-controlled trial of G-CSF in patients receiving systemic chemotherapy .  Application of the model to institutionally generated cost figures provides comparative estimates of excess cost favoring the prophylactic use of CSFs . Model thresholds were calculated based on sensitivity analysis comparing no CSF to prophylactic CSF , and therapeutic CSF to prophylactic CSF . Guidelines are provided based on this model that are consistent with those adopted by the American Society of Clinical Oncology After anecdotal reports of marijuana 's providing antiemetic activity in cancer chemotherapy patients refractory to st and ard agents , orally administered delta 9-tetrahydrocannabinol ( THC ) was formally studied by a number of investigators . In six of seven well-controlled studies , orally administered THC was a superior antiemetic agent compared with control agents . The THC toxic effects are notable but manageable . Patients rarely require hospitalization after the development of THC-induced dysphorias . However , serious toxic effects are uncommon and the most frequently noted effects are somnolence , conjunctivitis , and tachycardias . Because certain subgroups of patients are more prone to have toxicities develop , careful selection of the c and i date s to receive this agent is m and atory . Overall , the benefits of orally administered THC use represent a major advance in antiemetic therapy BACKGROUND AND PURPOSE During the first decade of the 21st century a number of important European r and omized studies were published . In order to help shape clinical practice based on best scientific evidence from the literature , the International Conference on ' Multidisciplinary Rectal Cancer Treatment : Looking for an European Consensus ' ( EURECA-CC2 ) was organized in Italy under the endorsement of European Society of Medical Oncology ( ESMO ) , European Society of Surgical Oncology ( ESSO ) , and European Society of Therapeutic Radiation Oncology ( ESTRO ) . METHODS Consensus was achieved using the Delphi method . The document was available to all Committee members as a web-based document customized for the consensus process . Eight chapters were identified : epidemiology , diagnostics , pathology , surgery , radiotherapy and chemotherapy , treatment toxicity and quality of life , follow-up , and research questions . Each chapter was subdivided by a topic , and a series of statements were developed . Each member commented and voted , sentence by sentence thrice . Sentences upon which an agreement was not reached after voting round # 2 were openly debated during a Consensus Conference in Perugia ( Italy ) from 11 December to 13 December 2008 . A h and -held televoting system collected the opinions of both the Committee members and the audience after each debate . The Executive Committee scored percentage consensus based on three categories : " large consensus " , " moderate consensus " , and " minimum consensus " . RESULTS The total number of the voted sentences was 207 . Of the 207 , 86 % achieved large consensus , 13 % achieved moderate consensus , and only 3 ( 1 % ) result ed in minimum consensus . No statement was disagreed by more than 50 % of the members . All chapters were voted on by at least 75 % of the members , and the majority was voted on by > 85 % . CONCLUSIONS This Consensus Conference represents an expertise opinion process that may help shape future programs , investigational protocol s , and guidelines for staging and treatment of rectal cancer throughout Europe AIM Final 10-year analysis of the prospect i ve r and omised Chemo-N0 trial is presented . Based on the Chemo-N0 interim results and an European Organisation for Research and Treatment of Cancer ( EORTC ) pooled analysis ( n=8377 ) , American Society of Clinical Oncology ( ASCO ) and Arbeitsgemeinschaft Gynäkologische Onkologie ( AGO ) guidelines recommend invasion and metastasis markers urokinase-type plasminogen activator (uPA)/plasminogen activator inhibitor-1 ( PAI-1 ) for risk assessment and treatment decision in node-negative ( N0 ) breast cancer ( BC ) . METHODS The final Chemo-N0 trial analysis ( recruitment 1993 - 1998 ; n=647 ; 12 centres ) comprises 113 ( 5 - 167 ) months of median follow-up . Patients with low-uPA and PAI-1 tumour tissue levels ( n=283 ) were observed . External quality assurance guaranteed uPA/PAI-1 enzyme-linked immunosorbent assay ( ELISA ) st and ardisation . Of 364 high uPA and /or PAI-1 patients , 242 agreed to r and omisation for CMF chemotherapy ( n=117 ) versus observation ( n=125 ) . RESULTS Actuarial 10-year recurrence rate ( without any adjuvant systemic therapy ) for high-uPA/PAI-1 observation group patients ( r and omised and non-r and omised ) was 23.0 % , in contrast to only 12.9 % for low-uPA/PAI-1 patients ( plog-rank=0.011 ) . High-risk patients r and omised to cyclophosphamide-methotrexate-5-fluorouracil ( CMF ) therapy had a 26.0 % lower estimated probability of disease recurrence than those r and omised for observation ( intention-to-treat (ITT)- analysis : hazard ratio ( HR ) 0.74 ( 0.44 - 1.27 ) ; plog-rank=0.28 ) . Per- protocol analysis demonstrated significant treatment benefit : HR 0.48 ( 0.26 - 0.88 ) , p=0.019 , disease-free survival ( DFS ) Cox regression , adjusted for tumour stage and grade . CONCLUSIONS Chemo-N0 is the first prospect i ve biomarker-based therapy trial in early BC defining patients reaching good long-term DFS without adjuvant systemic therapy . Using a st and ardised uPA/PAI-1 ELISA , almost half of N0- patients could be spared chemotherapy , while high-risk patients benefit from adjuvant chemotherapy . These 10-year results vali date the long-term prognostic impact of uPA/PAI-1 and the benefit from  adjuvant chemotherapy  in the high-uPA/PAI-1 group at highest level of evidence . They thus support the guideline -based routine use of uPA/PAI-1 for risk-adapted individualised therapy decisions in N0 breast cancer OBJECTIVE To summarize the discussion that took place at a public workshop , co-sponsored by the U.S. Food and Drug Administration , the American Urological Association , and Society of Urologic Oncology review ing the current state of the art for partial gl and ablation ( PGA ) for the management of patients with prostate cancer . The purpose of this workshop was to discuss potential indications , current available evidence , and design s for future trials to provide the evidence needed by patients and providers to decide how and when to use PGA . METHODS A workshop evaluating  PGA for prostate cancer was held in New Orleans , Louisiana , in May 2015 . Invited experts representing all stakeholders and attendees discussed the regulatory development of medical products , technology available , potential indications , and design s of trials to evaluate this modality of therapy . RESULTS The panel presented the current information on the technologies available to perform PGA , the potential indications , and results of prior consensus conferences . Use of magnetic resonance imaging for patient selection , guide therapy , and follow-up was discussed . Design s of trials to assess PGA outcomes were discussed . CONCLUSION The general consensus was that currently available technologies are capable of selective ablation with reasonable accuracy , but that criteria for patient selection remain debatable , and long-term cancer control remains to be established in properly design ed and well-performed prospect i ve clinical trials . Concerns include the potential for excessive , unnecessary use in patients with low-risk cancer and , conversely , that current diagnostic techniques may underestimate the extent and aggressiveness of some cancers , leading to inadequate treatment PURPOSE To develop an evidence -based guideline on central venous catheter ( CVC ) care for patients with cancer that addresses catheter type , insertion site , and placement as well as prophylaxis and management of both catheter-related infection and thrombosis . METHODS A systematic search of MEDLINE and the Cochrane Library ( 1980 to July 2012 ) identified relevant articles published in English . RESULTS The overall quality of the r and omized controlled trial evidence was rated as good . There is consistency among meta-analyses and guidelines compiled by other groups as well . RECOMMENDATIONS There is insufficient evidence to recommend one CVC type or insertion site ; femoral catheterization should be avoided . CVC should be placed by well-trained providers , and the use of a CVC clinical care bundle is recommended . The use of antimicrobial/antiseptic-impregnated and /or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs , particularly in high-risk groups ; more research is needed . The prophylactic use of systemic antibiotics is not recommended before insertion . Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy ; more research is needed . Before starting antibiotic therapy , cultures should be obtained . Some life-threatening infections require immediate catheter removal , but most can be treated with antimicrobial therapy while the CVC remains in place . Routine flushing with saline is recommended . Prophylactic use of warfarin or low-molecular weight heparin is not recommended , although a tissue plasminogen activator ( t-PA ) is recommended to restore patency to occluded catheters . CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy Goals In this multicenter crossover study , our aim was to evaluate the efficacy and acceptance of acupuncture as a supportive antiemetic approach during highly emetogenic chemotherapy in pediatric oncology . Patients and methods Eleven children receiving several courses of highly emetogenic chemotherapy for treatment of solid tumors were included . R and omization allocated patients to start chemotherapy either with antiemetic medication plus acupuncture or antiemetic medication alone . During all study courses , patients continued to receive their programmed and additional antiemetic medication as needed . Acupuncture was given at day 1 of chemotherapy and at subsequent days on patient ’s dem and . The amount of baseline and additional antiemetic medication during chemotherapy was documented . Patients maintained a daily diary of vomiting episodes and completed an evaluated nausea score at the end of every course . Their body weight was taken before and after a chemotherapy course . Main results Twenty-two courses with or without acupuncture were compared . The benefits of acupuncture in adolescents with respect to the reduction of additional antiemetic medication were observed . Acupuncture enabled patients to experience higher levels of alertness during chemotherapy and reduced nausea and vomiting . Except for needle pain , no side effects were noted . Patient ’s acceptance of acupuncture was high . Conclusion Our data indicate that acupuncture might reduce antiemetic medication and episodes of vomiting in pediatric oncology
For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics .
In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis .
The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk .
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology .