Linear endobronchial ultrasound-guided sampling of accessible mediastinal lesions is well established as a first-choice modality for lung cancer mediastinal staging. Parenchymal lung lesions, however, are routinely accessed by either a percutaneous (computed tomography guided) or a bronchoscopic approach. Direct comparisons between the percutaneous approach and bronchoscopy, endobronchial ultrasound, or mediastinoscopy are sparse in regard to diagnostic accuracy, and it remains unknown which sampling technique is the safest and offers the most adequate material for comprehensive biomarker testing. This guideline addresses new evidence and aims to answer these questions relevant to contemporary lung cancer clinical practice. A multidisciplinary expert panel from the American Association of Bronchology and Interventional Pulmonology and the Early Detection and Screening Committee of the International Association for the Study of Lung Cancer was convened to address four Patient, Intervention, Comparison, and Outcome questions pertaining to the safety and adequacy of comprehensive biomarker testing for frequently used intrathoracic biopsy techniques. The panel included 24 experts in thoracic procedures, including 18 pulmonologists, two radiologists, one pathologist, and three thoracic surgeons from 22 hospitals across 12 countries. All panel members participated in the development of the final recommendations using a modified Delphi technique. Specific recommendations are provided on safety and adequacy of minimally invasive thoracic interventions on patients with confirmed or suspected lung cancer for which comprehensive biomarker testing is needed for standard of care or clinical trial participation.

Radiation therapy planning for nasopharyngeal carcinoma is one of the most challenging tasks for radiation oncologists due to the notoriously narrow therapeutic margin. The first International Guideline (IG-2018 Version) has served as a practical guide for contouring clinical target volumes (CTVs). With increasing data on locoregional extension patterns and outcomes from studies on optimizing CTV and doses, an updated International Guideline is pressingly needed to provide a reference for enhancing precision.

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.

To develop a clinical practice guideline and recommendations for symptom management of patients with well-differentiated grade 1 to grade 3 metastatic gastroenteropancreatic neuroendocrine tumors.

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.

Metastatic clear-cell renal cell carcinoma (mccRCC) remains a major cause of morbidity and mortality among patients with kidney cancer. Over the past two decades, mccRCC treatment has significantly evolved with the incorporation of antiangiogenic tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) as the cornerstone of systemic therapy. In response, major international guidelines have continuously updated their recommendations according to emerging evidence from clinical trials. We provide an overview of current management recommendations for mccRCC, including cytoreductive nephrectomy (CN), active surveillance (AS), first-line treatment, and subsequent-line treatment. While upfront CN is no longer recommended for unselected patients, it remains an option for carefully selected patients with a limited metastatic burden. AS can be considered for those with slow-growing, asymptomatic, low-volume disease. First-line treatment strategies now prioritize ICI based combinations tailored to patient risk factors, comorbidities, and disease characteristics. In subsequent lines, treatment sequencing remains a challenge, with ongoing research needed to refine therapeutic choices. As new evidence emerges, treatment strategies must continue to adapt, underscoring the need for ongoing updates to clinical guidelines. PATIENT SUMMARY: Clinical trials are continuously identifying new treatments for advanced kidney cancer. Our guideline provides updated treatment recommendations from international societies that are based on evidence from these trials. Personalized treatment can improve the care and outcomes for patients with advanced kidney cancer.

Esophagectomy has been a cornerstone of the treatment of nonmetastatic esophageal cancer, but its use has evolved with advances in endoscopic resection techniques, systemic therapy, and radiation. This document reviews the existing literature and reports multidisciplinary consensus and specific recommendations on how best to treat esophageal and gastroesophageal junction cancer at different stages, including difficult clinical scenarios.

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).