骨癌2022.v2（英文）-NCCN腫瘤臨床實(shí)踐指南

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines?)BoneCancerrsionOctoberNCCNGuidelinesforPatients?availableat/patientsVersion2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.*J.SybilBiermann,MD/Chair?τUniversityofMichiganRogelCancerCenter*AngelaHirbe,MD,PhD/Vice-Chair?SitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineWarrenChow,MD??CityofHopeNationalMedicalCenterlasMBernthalMDSarahBoles,MD??cerCenterBrianBrigman,MD,PhD?τAlexandraK.Callan,MDτ?CenterLeeD.Cranmer,MD,PhD?TSeattleCancerCareAllianceSaeedDianat,MDфnterEricDonnelly,MD§NicolaFabbri,MD?τesPanelDisclosuresJohnGroundland,MD?SusanM.Hiniker,MD§MargoL.Hoover-Regan,MD€UniversityofWisconsinLisaKafchinski,MDτ?O'NealComprehensiveCancerCenteratUABJosephB.Kuechle,MD,PhD?τlParkComprehensiveCancerCenterDieterLindskog,MDτYaleCancerCenter/SmilowCancerHospitalDavidR.Lucas,MD≠UniversityofMichiganRogelCancerCenterJoelL.Mayerson,MD?τeCancerCenterJamesCancerHospitalSeanV.McGarry,MDτ?Fred&PamelaBuffettCancerCenterCarolD.Morris,MD,MS?τkinsR.LorRandall,MD,FACS?τUCDavisComprehensiveCancerCenterDamonR.Reed,MD€PeterS.Rose,MDτ?VictorM.Santana,MD€St.JudeChildren’sResearchHospital/TheUniversityofTennesseeHealthScienceCenterRobertL.Satcher,MD,PhD?τTheUniversityofTexasJosephSchwab,MD,MSτHerbertSchwartz,MD?τVanderbilt-IngramCancerCenterBreelynA.Wilky,MD?UniversityofColoradoCancerCenterRosannaL.Wustrack,MD?τUCSFHelenDillerFamilyCenterangPhDsticInterventional?Hematology/HematologiconcologyTInternalmedicine?MedicaloncologyτOrthopedics€§?*athologyPediatriconcologyRadiotherapy/RadiationoncologySurgery/SurgicaloncologyDiscussionWritingaryoftheGuidelinesUpdatesupBONEPrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.NotapprovedforaryoftheGuidelinesUpdatesupBONEdexerPanelMemberscoma?Presentation(CHON-1)?PrimaryTreatment,LowGradeandIntracompartmental(CHON-2)?PrimaryTreatment,HighGrade,ClearCell,orExtracompartmental(CHON-3)?MetastaticChondrosarcoma(CHON-4)?WorkupandHistologicSubtype(CHOR-1)?PresentationandPrimary/AdjuvantTreatment(CHOR-2)?SurveillanceandRecurrence(CHOR-3)EwingSarcoma:?Workup,PrimaryTreatment,Restage(EW-1)?AdjuvantTreatment,Surveillance,andRelapse(EW-2)?MetastaticDisease(EW-3)GiantCellTumorofBone:?WorkupandPresentation(GCTB-1)?PrimaryTreatment(GCTB-2)?Surveillance,Recurrence(GCTB-3)oma?WorkupandPrimaryTreatment(OSTEO-1)?NeoadjuvantandAdjuvantTreatment(OSTEO-2)?MetastaticDisease(OSTEO-3)?SurveillanceandRelapse(OSTEO-4)ofBoneCancerManagementBONEABONEBlesofRadiationTherapyBONEClievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.FindanNCCNMemberInstitution:/home/member-institutions.ofEvidenceanddationsotherwisedNCategoriesofEvidenceandConsensus.NCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.SeeNCCNCategoriesofPreference.TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatmentAnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualclinicalcircumstancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetwork?(NCCN?)makesnorepresentationsorwarrantiesofanykindregardingtheircontent,useorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinghtsreservedTheNCCNGuidelinesandtheillustrationshereinmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.?2021.Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESVersion2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.?Thefollowingreferenceupdated:CampbellKM,etal.PediatrBloodCancer;68:e28807.CHONcorrespondingto"dedifferentiated."?"SeeOSTEO-1"deleted.Modifiedfootnotek":Considertestingfortumormutationalburden(TMB)andMMRMSI?Thefollowingreferenceupdated:CampbellKM,etal.PediatrBloodCancer;68:e28807.CHONcorrespondingto"dedifferentiated."?"SeeOSTEO-1"deleted.Modifiedfootnotek":Considertestingfortumormutationalburden(TMB)andMMRMSIasdeterminedbyavalidatedand/orFDA-approvedassayastatictumorswhohaveprogressedfollowingpriortreatmentandwhotoryalternativetreatmentoptionsNotforGiantCellTumortoinformtheuseofpembrolizumab.(AlsoforCHOR-3,EW-3,OSTEO-3).Mayconsidertreatingasosteosarcoma(category2B)"textmovedfromforupto10yofBone.critical.DeletedthefollowingfootnoteForlaterelapse,considerre-treatmentwithivosidenib.dexVersionoftheNCCNGuidelinesforBoneCancerfromVersionincludeBONE-B(1of5)?Footnote"a"modified:removed"orChordoma"fromthelastsentence.MS-1?TheDiscussionhasbeenupdatedtoreflectthechangestothealgorithm.VersionoftheNCCNGuidelinesforBoneCancerfromVersionincludeTEAM-1?Palliativecarephysicianhasbeenaddedto"SpecialistsCriticalinCertainCases"BONE-1?"?"Age"addedto?40and≥40.ChondrosarcomaaddedalinktoCHON-4.?Deleteddedifferentiatedarm"(TreatasosteosarcomaaddedalinktoCHON-4.MetastaticChondrosarcoma?Addedthefollowingfootnotetothetitle:ConsidercomprehensivegenomictargetedtherapyopportunitiesAlsoforCHOR-3,EW-3,OSTEO-3,).profiling(CGP)withtargetedtherapyopportunitiesAlsoforCHOR-3,EW-3,OSTEO-3,).ChordomaMRI±CT)andscreeningMRIofspinalaxis(CT/MRIMRI/CTwithcontrast).?Bullet3,modified:MRI±CT)andscreeningMRIofspinalaxis(CT/MRIMRI/CTwithcontrast).CHOR-3callyindicatedegxrayMRICTwithcontrastMRICTwithcontrastcallyindicatedegxrayMRICTwithcontrastMRICTwithcontrastEwingSarcoma?ConsiderCGPorotherfusionpanelforEwingsarcomatoidentifyisnegative,isanewfootnotecorrespondingtoEwingsarcoma.translocationsisnegative,isanewfootnotecorrespondingtoEwingsarcoma.ProgressiveDisease/RelapseRTsurgery"?Relapseinplaceof"Earlyrelapse"andRTsurgery"eviouslyeffectiveregimeneviouslyeffectiveregimenupGiantCellTumorofupBullet2,modified:ImagingofprimarysiteasclinicallyindicatedBullet2,modified:Imagingofprimarysiteasclinicallyindicated(eg,x-rayGCTB-2correspondingtodenosumab.?Considerconsultationwithdentistpriortoinitialtherapy,iscorrespondingtodenosumab.Surveillancethereafter?Bullet3,modified:Chestimagingevery6–12mofor24ythenthereafterBONE-APrinciplesofBoneCancerManagement?Biopsymusculoskeletalorinterventionalradiologist,andbonepathologistispBullet8,musculoskeletalorinterventionalradiologist,andbonepathologistisBONE-B(1of5)BONE-B(1of5)NGSortargetedexonsequencingisanewfootnotecorrespondingto?NGSortargetedexonsequencingisanewfootnotecorrespondingtoargetedtherapyopportunitiesTMBHforpatientswithunresectableorargetedtherapyopportunitiesTMBHforpatientswithunresectableorPrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexPrimarybonetumorsandselectedmetastatictumorsshouldbeevaluatedandtreatedbyamultidisciplinaryteamwithexpertiseinthemanagementofthesetumorsTheteamshouldmeetonaregularbasisandshouldinclude:CoreGroup?Orthopediconcologist?Bonepathologist?Medical/pediatriconcologist?Radiationoncologist?MusculoskeletalradiologistSpecialistsCriticalinCertainCases?Thoracicsurgeon?Plasticsurgeon?Interventionalradiologist?Physiatrist?Vascular/generalsurgeon?Neurosurgeon/orthopedicspinesurgeon?Palliativecarephysician?AdditionalsurgicalsubspecialtiesasclinicallyindicatedNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.TEAM-1Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexWORKUPgegeRefertoorthopediconcologist?Biopsy,ifindicated,tinginstitutiontinginstitutionborkupforbonesasyindicated?Historyandphysical?BonescanorPET/CT(category2B)labsc?labsc?Chest/abdominal/pelvicCTwithcontrast?PSAmogramnsleboneOtherlesions(Non-boneprimarysuspected)oneCancerorspecificbonecomasRefertoorthopediconcologist?BiopsyshouldbeperformedattreatinginstitutionRefertoappropriateNCCNGuidelinesforTreatmentbyCancerTypeaSeeMultidisciplinaryTeam(TEAM-1).bSeePrinciplesofBoneCancerManagement(BONE-A).cLabsincludeCBCandcomprehensivemetabolicpanel(CMP)withcalciumtoassessforhypercalcemia.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.BONE-1PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexPRESENTATIONa,b,ctalNNN(gradell,gradelll)orClearcellorExtracompartmentalMetastaticdiseaseatpresentationSeeCHON-4 SeeCHON-4 TreatasEwingsarcoma(category2B)MesenchymalSee TreatasEwingsarcoma(category2B)aSeeMultidisciplinaryTeam(TEAM-1).bSeePrinciplesofBoneCancerManagement(BONE-A).cThereisconsiderablecontroversyregardingthegradingofchondrosarcoma.Inadditiontohistology,radiologicfeatures,size,andlocationoftumorsshouldalsobeconsideredindecidinglocaltreatment.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.CHON-1PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dextalPRIMARYTREATMENTIntralesionalideexcisioneexcisionideexcisioneConsiderRT,fifunresectable(category2B)SURVEILLANCE?Physicalexam?Radiographsofprimarysiteand/orcross-sectionalimagingMRIorCT(bothwithcontrast)asclinicallyindicatedevery6–12mofor2y,thenyearlyasappropriate?Chestimagingasclinicallyindicatedevery6–12mofor2y,thenyearlyasappropriateRECURRENCE dedeBConsiderRTf(category2B)Considerre-resectiontoachievenegativesurgicalmarginsdThismanagementshouldberestrictedtoextremitytumors(notpelvictumors).eWideexcisionshouldprovidehistologicallynegativesurgicalmargins.Thismaybeachievedbyeitherlimb-sparingresectionorlimbamputation.fSeePrinciplesofRadiationTherapy(BONE-C).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.CHON-2Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.mayincludeCThatleastevery6mofor5y,thenyearlyforaminimumof10y?Reassessfunctionateveryfollow-upvisitysicalexamadiographsofprimaryteandorcrosssectionalmayincludeCThatleastevery6mofor5y,thenyearlyforaminimumof10y?Reassessfunctionateveryfollow-upvisitysicalexamadiographsofprimaryteandorcrosssectionalRIorCTbothwithcontrast)asclinicallydexPRIMARYSURVEILLANCERECURRENCETREATMENTHighgrade(gradell,gradelll)orClearcellorExtracompartmentaldeedeeleorBLocalLocalBdedeConsiderRT(category2B)Considerre-resectiontoachievenegativesurgicalmargins?Chestimaginggevery?Chestimaginggevery3–6morecurrence(CHON-4)Systemicrecurrence(CHON-4)eWideexcisionshouldprovidehistologicallynegativesurgicalmargins.Thismaybeachievedbyeitherlimb-sparingresectionorlimbamputation.fSeePrinciplesofRadiationTherapy(BONE-C).gBasedonphysician'sconcernforriskofrecurrence.hChestCTwithorwithoutcontrastasclinicallyindicated.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.CHON-3Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexMETASTATICCHONDROSARCOMAirosarcomastaticWidespreaddiseaseSurgicalexcisionofallsitesifpossibleerradiationforunresectablesitesclinicaltrialrablativetherapiesforsymptomaticsitesersystemictherapykSeeSystemicTherapyAgents(BONE-B)clinicaltrialiConsidercomprehensivegenomicprofiling(CGP)withavalidatedand/orFDA-approvedassaytodeterminetargetedtherapyopportunities.jMayconsidertreatingasosteosarcoma(category2B).kConsidertestingfortumormutationalburden(TMB)andMMR/MSIasdeterminedbyavalidatedand/orFDA-approvedassaytoinformtheuseofpembrolizumab.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.CHON-4Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.storyandphysicalPrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.storyandphysicaldexWORKUPaHISTOLOGICSUBTYPE?Allpatientsshouldbeevaluatedandtreatedbyamultidisciplinaryteamwithexpertiseinthemanagement?Adequateimagingofprimarysite(eg,x-ray,MRI±CT)andscreeningMRIofspinalaxis(MRI/CTwithcontrast)?Chest/abdominal/pelvicCTwithcontrast?ConsiderPET/CT(skullbasetomid-thigh)?ConsiderbonescanifPET/CTisnegativealorChondroidesentationandPrimaryRPoorlydifferentiatedorDedifferentiatedSeeNCCNGuidelinesforSoftTissueSarcomaultidisciplinaryTeamTEAMNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.CHOR-1ancectionPrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.ancectiondexPRESENTATIONPRIMARYTREATMENTADJUVANTTREATMENTSacrococcygealandMobilespineSkullbase/ClivalTcdforpositivesurgicalmarginsorforartmentaltumorsConsiderRTddbSeePrinciplesofBoneCancerManagement(BONE-A).cRadiationtherapymaybegivenpreoperatively,intraoperatively,and/orpostoperatively.dSeePrinciplesofRadiationTherapy(BONE-C).eMaximalsaferesection.Maximaltumorremovalisrecommendedwhenappropriate.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.CHOR-2Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexSURVEILLANCERECURRENCEfTREATMENT?Physicalexam?Chestimaginggevery6moannuallyforythenannuallythereafter?Imagingofsurgicalsite,timing,andmodality,asclinicallyindicated(?Chestimaginggevery6moannuallyforythenannuallythereafterrrrctherapyhlexcisionbrlexcisionbrrand/orBestsupportivecarebSeePrinciplesofBoneCancerManagement(BONE-A).dSeePrinciplesofRadiationTherapy(BONE-C).fConsiderCGPwithavalidatedand/orFDA-approvedassaytodeterminetargetedtherapyopportunities.gChestCTwithorwithoutcontrastasclinicallyindicated.hSeeBoneCancerSystemicTherapyAgents(BONE-B).iConsidertestingforTMBandMMR/MSIasdeterminedbyavalidatedand/orFDA-approvedassaytoinformtheuseofpembrolizumab.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.CHOR-3Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexPRESENTATIONa,b,cWORKUP?HistoryandphysicalCTe?MRI±CT(bothwithcontrast)CTe?PET/CT(head-to-toe)and/orbonescan?Considerbonemarrowbiopsyand/ordpelvisfscreeningMRIdpelvisfCytogeneticsandCytogeneticsandor(mayrequirere-biopsy)?LDHilityconsultationuldbeconsideredRESTAGEPRESTAGETREATMENTapyjchemotherapyhchemotherapyh(category1)foratleast9weekspriortolocalCTe?CTe?MRI±CT(bothwithcontrast)ofprimarysite?Radiographsofprimarysite?ConsiderPET/CTadtotoeoronescanipeatotherlstudieszedResponse,metastaticdisease(EW-3)Progressivedisease(EW-2)aSeeMultidisciplinaryTeam(TEAM-1).bSeePrinciplesofBoneCancerManagement(BONE-A).cEwingsarcomacanbetreatedusingthisalgorithm,includingprimitiveneuroectodermaltumorofbone,Askintumor,andextraosseousEwingsarcoma.dConsiderCGPorotherfusionpanelforEwingsarcomatoidentifytranslocationsifpathologicworkupoftargetedPCR,FISH,orcytogeneticsisnegative.eChestCTwithorwithoutcontrastasclinicallyindicated.fCampbellKM,etal.PediatrBloodCancer2021;68:e28807.gNinetypercentofEwingsarcomawillhaveoneoffourspecificcytogenetictranslocations.ForpatientswithEwing-likesarcoma(eg,CIC-DUX4)analternatetreatmentparadigmcanbeconsidered.Forthosewhoarenegative,additionalmoleculartestingisrecommended.hSeeBoneCancerSystemicTherapyAgents(BONE-B).iUsethesameimagingtechniquethatwasperformedintheinitialworkup.jLongertreatmentpriortolocalcontroltherapycanbeconsideredinpatientswithmetastaticdiseasebasedonresponse.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,10/08/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.arginslyh Relapse±m(xù)provedollowingeatmentPrintedbyMinTangon12/20/202111:24:30AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2021National