Despite significant improvements in survival of patients with multiple myeloma (MM), outcomes remain heterogeneous, and a significant proportion of patients experience suboptimal outcomes. Importantly, traditional prognostic factors based on data from patients treated with older therapies no longer capture prognosis accurately in the contemporary era of novel triplet or quadruplet therapies. Therefore, risk stratification requires refinement in the context of available and investigational treatment options in routine practice and clinical trials, respectively. The current identification of high-risk MM (HRMM) in routine practice is based on the Revised International Staging System, which stratifies patients using a combination of widely available serum biomarkers and chromosomal abnormalities assessed via fluorescence in situ hybridization. In recent years, a substantial body of evidence concerning additional clinical, biological, and molecular/genomic prognostic factors has accumulated, along with new MM risk stratification tools and consensus reports. The International Myeloma Society, along with the International Myeloma Working Group, convened an Expert Panel with the primary aim of revisiting the definition of HRMM and formulating a practical and data-driven consensus definition, based on new evidence from molecular/genomic assays, updated clinical data, and contemporary risk stratification concepts. The Panel proposes the following Consensus Genomic Staging (CGS) of HRMM which relies upon the presence of at least one of these abnormalities: (1) del(17p), with a cutoff of >20% clonal fraction, and/or TP53 mutation; (2) an IgH translocation including t(4;14), t(14;16), or t(14;20) along with 1q+ and/or del(1p32); (3) monoallelic del(1p32) along with 1q+ or biallelic del(1p32); or (4) β2 microglobulin ≥5.5 mg/L with normal creatinine (<1.2 mg/dL).

The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize important considerations for adding interstitial needles to intracavitary implants for cervix cancer brachytherapy.

Biliary tract cancers (BTC) are aggressive and fatal. Early recognition of symptoms and proper diagnostic work up allow for precise histopathological and molecular classification as well as accurate evaluation of the extent of disease. Surgery is the only potentially curative therapy in localized stages; however, disease recurrence is common and adjuvant chemotherapy appears to improve survival. Upfront systemic chemotherapy with immunotherapy is the treatment of choice in unresectable locally-advanced and metastatic disease. Inroads made in understanding its molecular biology has enabled new therapeutic targets to be identified with current indications and encouraging results that could further improve BTC patients' survival and quality of life.

Mycosis fungoides (MF) is considered rare in children and adolescents. Accumulating experience indicates that compared with adult patients, almost all paediatric patients with MF are diagnosed at an early stage of disease, exhibit higher rates of atypical presentations and follow a notably indolent course. Despite the need for special staging/investigations specific for children and adolescents, the staging of paediatric MF is currently based primarily on standard practice in adults. The aim of this work was to develop staging recommendations specifically designed for MF in children and adolescents, on behalf of the three largest societies for cutaneous lymphomas, the International Society for Cutaneous Lymphomas, the European Organisation for Research and Treatment of Cancer - Cutaneous Lymphoma Tumor Group, and the United States Cutaneous Lymphoma Consortium. We developed this guideline through an international expert consensus process and in accordance with the EQUATOR Network's recommendations for guideline development. A modified Delphi process was conducted, using questionnaires covering topics including the definition, characteristics and staging of paediatric MF. Two rounds of expert feedback were conducted, with an additional hybrid consensus meeting. We reached a consensus that the term 'paediatric MF' should be reserved for MF diagnosed at ≤ 18 years of age. Panellists specified the unique clinical characteristics of paediatric MF, including a high prevalence of hypopigmented and folliculotropic variants, and reached a consensus on the indolent nature of the disease during childhood and adolescence with rare progression to advanced stage. The consensus reached recommends that while the staging approach is largely similar to that in adults, imaging for early-stage paediatric MF should rely on ultrasound of the lymph nodes if indicated, rather than computed tomography with contrast or integrated with positron emission tomography. Along with this, clinicians should be aware that in children, palpable lymph nodes are common owing to the increased incidence of infectious diseases. In summary, this guideline addresses the major clinical characteristics of paediatric MF, which differ from those in adults, and provides practical staging recommendations considering the safety implications specific for this age group.

Despite the rarity of primary bone tumors, appropriate imaging evaluation is essential for diagnosis and management. Radiographs are the most appropriate initial imaging study for detection and characterization of the majority of primary bone tumors. Radiographs often provide sufficient information for the diagnosis of primary bone tumors, however, for radiographically occult primary bone tumors, MRI and/or CT can be performed. For indeterminate or aggressive bone tumors on radiographs, MRI or CT are typically the most appropriate next step for the evaluation of anatomic extent, assessment of viability and biopsy or surgical planning. This document focuses on five common variants to guide diagnosis and management of primary bone tumors. In addition to conventional radiographs, appropriate use of MRI, CT, PET/CT, bone scan, image-guided biopsy and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

This document aims to provide recommendations on the role of imaging in the diagnosis of squamous cell anal cancer, focusing on its use in locoregional and systemic assessment during initial staging, posttreatment evaluation, and surveillance. For initial locoregional staging, MRI of the pelvis and FDG-PET/CT are usually appropriate to complement clinical and digital rectal examinations, because they offer additional information regarding locoregional tumor invasion and nodal metastases. For metastatic disease assessment, which is rare in the initial presentation and commonly associated with recurrence-with lymph nodes, liver, and lungs being the most common sites of disease-CT and FDG-PET/CT are usually appropriate for detecting distant nodal metastases and other sites of metastatic disease. MRI of the abdomen may be appropriate as a problem-solving tool, particularly in assessing small or indeterminate liver lesions. For patients who have completed locoregional treatment, most typically achieve clinical complete response; consequently, few require surgery unless there is persistent disease or recurrence. The role of posttreatment imaging assessment is still debatable; however, in cases in which surgery is indicated, MRI and FDG-PET/CT are usually appropriate for assessing local tumor invasion and nodal metastases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

This document reviews the evidence supporting different imaging modalities and techniques used to evaluate patients with a history of lung cancer. It focuses on the imaging evaluation of patients treated for stage I-III non-small-cell lung cancer and small-cell lung cancer, whether using individual modalities or combinations. Guidelines for both routine surveillance of stage I-III lung cancer and for the evaluation of suspected recurrence or disease progression are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Ductal carcinoma in situ (DCIS) accounts for approximately 20% of diagnosed breast cancer. It is important to understand which imaging studies are appropriate in patients with a new diagnosis or history of DCIS. Initial imaging for a new diagnosis of DCIS, consists of diagnostic mammography and/or tomosynthesis, whereas breast ultrasound and breast MRI may be appropriate as complementary examinations. Routine surveillance with annual mammography and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women who have completed breast conservation therapy for DCIS, and breast MRI may be appropriate. Advanced technologies such as contrast mammography or molecular breast imaging are usually not appropriate. In a patient with a history of mastectomy for DCIS, routine surveillance for ipsilateral recurrence with imaging is usually not appropriate. There is no role for imaging of the axilla in patients with known DCIS with or without microinvasion. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

This article presents consensus recommendations by a multidisciplinary panel of endocrinologists, medical oncologists, pathologists, radiation oncologists, surgeons and nuclear medicine physicians. The recommendations specifically address iodine-refractory well-differentiated thyroid carcinoma and locally advanced and/or metastatic medullary thyroid carcinoma. Treatment algorithms based on risk-benefit assessments of various multimodal therapeutic approaches are proposed for each clinical scenario. Given the limited data available on the management of these rare but aggressive forms of thyroid cancer, these consensus recommendations provide essential guidance for multidisciplinary teams to ensure optimal care for patients with these complex thyroid carcinomas.

Complete mesocolic excision (CME) is a surgical technique that aims to improve oncological outcomes of right-sided colon cancer resections. However, CME's technical complexity, surgical risks, and need for specialized training, present challenges. Also, variations in technical aspects and implementation lead to inconsistent outcomes.

Anaplastic thyroid cancer is a rare and rapidly deadly disease. In case of clinical suspicion (rapid growth, stony neck mass), diagnostic work-up should be carried out as a matter of urgency to enable prompt treatment. Multidisciplinary assessment involving the patient's referring specialists, the support care team, and if necessary, a geriatric oncology specialist should be performed and must take account of disease extent, comorbidities, general health status and the patient's wishes. Patients and their families should receive realistic information about the prognosis; either active treatment in parallel to support care or exclusive palliative care can be recommended from the outset. Despite the dismal prognosis, recent advances in tumor molecular profiling and treatment with the advent of targeted treatment and immunotherapy hold out great promise for the future. This article summarizes the consensus recommendations on management of anaplastic thyroid cancers by the ENDOCAN TUTHYREF network, a rare-cancer network of the French National Institute for Cancer (INCa).

Recent years have witnessed significant advances in the imaging, molecular profiling, and systemic treatment of cholangiocarcinoma (CCA). Despite this progress, the early detection, precise classification, and effective management of CCA remain challenging. Owing to recent developments and the significant differences in CCA subtypes, EASL commissioned a panel of experts to draft evidence-based recommendations on the management of extrahepatic CCA, comprising distal and perihilar CCA. Particular attention is given to the need for accurate classification systems, the integration of emerging molecular insights, and practical strategies for diagnosis and treatment that reflect real-world clinical scenarios.

Lymph node (LN) metastases are the most significant prognostic factor in penile cancer (PeC), so timely detection and adequate treatment of LN metastases is crucial. While open inguinal LN dissection (ILND) remains the standard for most cases, its morbidity has spurred interest in robot-assisted videoendoscopic ILND (RA-VEIL). We summarize current international guidelines and evidence on the current role of RA-VEIL in LN management for PeC. RA-VEIL is feasible and has been associated with fewer wound complications and an equivalent nodal yield in comparison to open ILND. However, lymphatic complications appear to remain the same. Therefore, for nodal staging in patients with cN0 PeC, sentinel node biopsy is preferred over RA-VEIL. In node-positive patients, more studies, especially prospective studies, are needed to confirm the long-term oncological safety of RA-VEIL before it can be incorporated in guidelines as a recommended treatment option. PATIENT SUMMARY: For patients with penile cancer, spread to the lymph nodes is a crucial factor in determining probable survival. We summarize the current role of a robot-assisted telescopic technique under video guidance for lymph node management. This technique is feasible and may lead to fewer wound infections, but lymphatic complications seem to be the same as with open surgery. More studies are needed to confirm the long-term cancer control outcomes of this technique.

Radioactive-iodine-refractory differentiated thyroid cancer (RAIR DTC) represents 3-5% of follicular-derived DTCs, with approximately 200-300 new cases diagnosed annually in France. Median overall survival in the French RAIR DTC database is 9.5years, underscoring the importance of long-term support for caregivers and patients. To guide treatment decision-making, the French ENDOCAN TUTHYREF network has provided algorithms for RAIR DTC management, available at the TUTHYREF website. The present article summarizes these recent practical recommendations, focusing on 5 points. (1) RAIR DTC has long been defined by locally advanced disease not amenable to surgery or metastatic disease not fully responding to radioactive iodine (RAI) therapy, a definition that can be further refined considering prognostic factors. (2) Treatment should be tailored according to tumor burden and progression, with local treatments prioritized for non-progressive or slowly progressive disease. (3) Early tumor molecular testing should be performed to identify driver oncogenes such as BRAF mutation or RET/NTRK/ALK fusion, to optimize access to existing selective targeted therapies. (4) For symptomatic or progressive RAIR DTC, tyrosine multikinase inhibitors, such as sorafenib, lenvatinib or cabozantinib, are the standard therapies, but alternative and 2nd-line kinase inhibitors are also available. (5) Since most therapies are associated with common side-effects such as fatigue and cardiovascular, digestive and skin issues, preparing and monitoring patients for systemic therapy should include careful assessment of comorbidities, toxicity prevention and individual dose adjustment. Overall, management of RAIR DTC requires a multidisciplinary approach, with an emphasis on personalized treatment strategies and proactive therapeutic education.

The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Many low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patients die from disease despite intensive multimodal treatment. Precise disease characterization for each patient at diagnosis is key for risk-adapted treatment. The guidelines presented here incorporate results from national and international clinical trials to produce recommendations for diagnosing and treating neuroblastoma patients in German hospitals outside of clinical trials.

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.

People with HIV are up to 100 times more likely to develop anal carcinoma compared to the general population. Diagnosing and treating precursor lesions, specifically high-grade anal dysplasia, can significantly reduce the risk of developing anal carcinoma. This S2k-guideline outlines the factors that increase the likelihood of developing anal carcinoma and its precursors, including advancing age, a low CD4+ T-lymphocyte nadir, active cigarette smoking, receptive anal intercourse, or persistent infection with high-risk (HR) types of human papillomavirus (HPV). Screening is primarily recommended for all men who have sex with men (MSM) and transgender women with HIV starting at age 35, and all people with HIV starting at age 45. After inspection and digital anorectal examination, anal cytology is collected. An HR-HPV test may be performed. If clinical abnormalities are present or if cytology shows "ASC-US or worse", a referral for high-resolution anoscopy (HRA) is indicated. If lesions are found during HRA, a biopsy should be obtained. Anal intraepithelial neoplasia (AIN) grade-III or AIN-II p16-positive correspond to high-grade dysplasia and require treatment. The most strongly recommended therapeutic options are electrocautery, 85% trichloroacetic acid, and surgical excision. Finally, the guideline discusses how these screening recommendations can be applied to individuals without HIV.

To provide evidence-based recommendations for patients with metastatic castration-resistant prostate cancer (mCRPC).

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in theASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).