Part I: NCCN Practice Guidelines Tabular Summary (DD 3/20/13) PET and PET/CT

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1 Part I: NCCN Practice Guidelines Tabular Summary (DD 3/20/13) PET and NCCN guidelines were reviewed on 3/20/2013 for utilization of PET and (available at: This tabular summary lists all of the practice guidelines, and indicates whether or not 18 F- fluorodeoyglucose (FDG) PET and are included. The NCCN terminology corresponds to the terminology used by CMS (ie diagnosis/staging = initial treatment strategy; therapy monitoring/recurrence = subsequent treatment strategy; surveillance not recognized by CMS as an indication). The NCCN wording and restrictions are stated. The language is not uniform and varies from panel to panel making the guidelines. NCCN is trying to address this but each guideline panel is independent from the others. Type of Cancer Diagnosis Initial Staging 1.ALL (2.2012): None 2.AML: None 3.Anal: 4.Bladder: None 5.Bone: PET Planning XR therapy Therapy Evaluation (interim) Restaging after therapy Suspected Recurrence Follow-up Surveillance Chordoma Chondrosarcoma: None Ewing Sarcoma Osteosarcoma (2B) 6.Breast: If FDG+ for bone mets, bone scan or fluoride PET not needed Invasive Inflammatory stage IIIA-IV (2B) Optional (2B)

2 7.CNS: FDG PET Guide biopsy Anaplastic Metastases Lymphoma (2B) Metastatic spine tumors 8.Cervical: CT or (multiple) 9. CML: None 10.Colon: Synchronous mets: Only if potentially surgically curable M1 disease 11.Rectal: see colon 12.Esophageal: or PET ( preferred) 13.Gastric: 14.Head and neck (2.2012): Occult Primary Nasopharyn Oral Cavity Oropharyn Hypopharyn Glottic Laryn Supraglottic Laryn Lip Ethmoid Sinuses Maillary Sinuses Salivary Glands Mucosal Melanoma as If no evidence of M1 disease If no evidence of M1 disease for for for for for for Post chemorad: (2B) as clinically at min 12 weeks Serial CEA elevation: and if neg again after 3 mo Metachronous mets resectable: 15.Hepatobiliary adequate adequate Rising AFP: Page 2

3 (2.2012): adequate Gallbladder Emerging evidence Cholangiocarcinoma Emerging evidence 16.Hodgkin s Lymph: (multiple) 17.Kidney: PET 18.Malignant Pleural Mesothelioma before pleurodesis 19.Melanoma: 20.Multiple Myeloma: 21.Systemic amyloidosis: none 22.Waldenstom: none 23.Myeolodysplastic Syndromes: none 24.Neuroendocrine (1.2012): FDG-PET 25.Non-Hodgkin s Lymphoma: CLL/SLL FCC Non-gastric MALT Nodal marginal zone Splenic marginal zone Mantle cell Unknown primary: FDG-PET Stage I-II: only to evaluate symptoms Stage III-IV Stage IIB- IV: every 3-12 mo helpful but can guide biopsy if Richter transformatio n Diffuse large B-cell essential X (multiple) Page 3

4 Burkitt Lymphoblastic AIDS-related B-cell X essential Primary cutaneous B- cell useful in Peripheral T-cell essential X (multiple) Mycosis fungoides Adult T-cell Etranodal NK/T-cell essential well established Post-transplant lympho-proliferative T-cell prolymphocytic leukemia 26.Basal and Squamous Cell (2.2012): none 27.Dermatofifrosarc oma(2.2012): none 28.Merkel Cell (1.2012): 29.Non-small Cell Lung: 30.Occult Primary 31.Ovarian 32.Pancreatic (2.2012): role unclear 33.Penile: needs larger studies 34.Prostate: FDG and fluoride are investigational 35.Small Cell Lung >8mm solid non-calcified nodule: Risk assessment: FDG avidity warranted in some situations If changes management If limited stage is suspected As clinically (2B) (2B) Page 4

5 Lung neuroendocrine 36.Soft Tissue Sarcoma (3-2012): PET Etremity/trunk Useful under certain circumstances Retroperitoneal/abdo minal GIST if CT is ambiguous Rhabodomyosarcoma Desmoid tumors 37.Testicular (1.2012) Seminoma May be useful Residual mass>3cma nd normal markers: PET at ~ 6 weeks posttherapy Non-Seminoma Limited predictive value for residual masses 38.Thymic Malignancies: 39.Thyroid: FDG Papillary Follicular Hurthle Medullary Anaplastic 40.Uterine Neoplasms Endometrial Uterine sarcoma Mediastinal mass Based on symptoms or clinical suspicion of mets Consider for 131 I neg,/tg>2-5ng/ml Consider for 131 I neg,/tg>2-5ng/ml Consider for 131 I neg,/tg>2-5ng/ml Page 5

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