Persius/hicric huggingface dataset:
# GUIDELINE OBJECTIVES
To make recommendations with respect to the use of T2-weighted magnetic resonance imaging (MRI)  functional sequences in the pre-treatment local staging of patients with newly diagnosed prostate cancer.
- MRI refers to T2-weighted MRI.
- Functional sequences include dynamic contrast-enhanced imaging (DCE), diffusionweighted imaging (DWI), and proton magnetic resonance spectroscopic imaging (MRS). - In this guideline, the terminology of MRI  functional sequences is used interchangeably with MRI  DCE, DWI, and MRS (See Glossary of Terms, Appendix 1).

# TARGET POPULATION
Men with newly diagnosed biopsy-confirmed prostate cancer who are under consideration for radical treatment.

# INTENDED USERS
Clinicians who are involved in the staging and treatment of prostate cancer patients.

# RECOMMENDATIONS Recommendation 1
Multiparametric MRI (mpMRI) use for pre-treatment local staging of prostate cancer is a reasonable option for assessment of extraprostatic extension (EPE) in intermediate-and highrisk patients being considered for radical therapy if knowledge of EPE will alter management.

# Qualifying Statements for Recommendation 1
- mpMRI is the addition of two or more functional sequences to
# Section 1:
Recommendations Section 2:
Recommendations and Key Evidence Section 3: Guideline Methods Overview Section 4: Systematic Review Section 5:
Internal and External Review
For information about this document, please contact Alex Sun, the lead author, through the PEBC via: Phone: 905-527-4322 ext. 42822 Fax: 905 526-6775 E-mail: ccopgi@mcmaster.ca For information about the PEBC and the most current version of all reports, please visit the CCO website at  or contact the PEBC office at: Phone: 905-527-4322 ext. 42822 Fax: 905 526-6775 E-mail: ccopgi@mcmaster.ca Copyright This report is copyrighted by Cancer Care Ontario; the report and the illustrations herein may not be reproduced without the express written permission of Cancer Care Ontario. Cancer Care Ontario reserves the right at any time, and at its sole discretion, to change or revoke this authorization.

# PEBC Report Citation (Vancouver
# RECOMMENDATIONS, KEY EVIDENCE, AND JUSTIFICATION
RECOMMENDATION 1 DNMT3A mutation testing should be included as a biomarker test in cytogenetically normal AML patients.

# Summary of Key Evidence for Recommendation
Four (8,10,13,15) of the eight studies (8)(9)(10)(11)(12)(13)(14)(15) included in the systematic review reported a statistically significant difference in Overall Survival (OS) between DNMT3A wild type (DNMT3A-wt) and DNMT3A-mutated (DNMT3A-mut) populations favouring the non-mutated gene; the remaining four that did not provide statistical data did demonstrate a similar trend. The meta-analysis of these data resulted in an overall estimated hazard ratio 1.66 (95%CI, 1.23-2.24; p=0.0010) favouring patients that are DNMT3A wild type. This strongly suggests that the mutational status of DNMT3A has prognostic value. However, the interpretation of the meta-analysis using OS may be limited by the fact that two studies were omitted as complete information was not available.

# Justification for Recommendation 1
The available evidence shows DNMT3A mutation status has good prognostic value in this patient population.

# Qualifying Statements for Recommendation 1
This recommendation is based on evidence currently available. Despite the heterogeneous nature of the studies included, the likelihood of having a series of large homogenous studies done in this patient population is low due to the nature of the disease and its management.

# FUTURE RESEARCH
Currently, there are no ongoing trials on DNMT3A mutation status in this patient population.
The PEBC is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health and Long-Term Care. All work produced by the PEBC is editorially independent from the Ontario Ministry of Health and Long-Term Care.
Updating All PEBC documents are maintained and updated as described in the PEBC Document Assessment and Review Protocol.
# INTENDED PURPOSE
- This recommendation report is primarily intended to guide the Ontario PET Steering Committee in their decision making concerning indications for the use of PET imaging.  This recommendation report may also be useful in informing clinical decision making regarding the appropriate role of PET imaging and in guiding priorities for future PET imaging research.

# RECOMMENDATIONS AND KEY EVIDENCE
These recommendations are based on an evidentiary foundation consisting of one recent high-quality systematic review from the U.S. Agency for Health Research and Quality (AHRQ) (1) that included primary study literature for the period from 2003 to March 2008.

# Diagnosis/Staging PET is not recommended for the determination of diagnosis or grading in gliomas.
Five studies (Chen et al Cher et al Liu et al Potzi et al Stockhammer et al assessed diagnostic accuracy and prognostic influence of PET scanning on survival, but none have demonstrated any additional diagnostic accuracy or prognostic influence over and above that provided by magnetic resonance imaging (MRI) and histology in a multivariate model.

# Qualifying Statement

# Assessment of Treatment Response
A recommendation cannot be made for or against the use of PET for the assessment of treatment response in gliomas due to insufficient evidence.
None of the studies discuss this question.

# Qualifying Statement
- Anecdotal evidence exists that PET/CT may differentiate radiation necrosis from tumour recurrence, but there is no gold standard for the diagnosis of radiation necrosis in glioblastoma multiforme.

# Recurrence/Restaging A recommendation cannot be made for or against the use of PET or PET/CT in the assessment of patients with recurrent gliomas due to insufficient evidence.
Two studies evaluating the use of PET included patients with recurrent gliomas (Chen et al Potzi et al. In both studies, fluorodeoxyglucose (FDG) PET was not the focus of the study but a comparison test for the tracer of interest, F-DOPA-PET in Chen et al (2) and Methionine-PET in Potzi et al (5). The evidence was insufficient to generate a recommendation on the use of FDG PET.

# Qualifying Statements
- PET or PET/CT has not been examined in a prospective cohort of gliomas to assess the treatment effect on PET imaging before and after treatment and correlate this with survival.  Radiation necrosis is a major factor in assessing recurrent gliomas.
The PEBC is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health and Long-Term Care through Cancer Care Ontario. All work produced by the PEBC is editorially independent from its funding source.
Copyright This report is copyrighted by Cancer Care Ontario; the report and the illustrations herein may not be reproduced without the express written permission of Cancer Care Ontario. Cancer Care Ontario reserves the right at any time, and at its sole discretion, to change or revoke this authorization.
# GUIDELINE OBJECTIVES
To update the 2015 guideline of the Program in Evidence-Based Care (PEBC) Ontario Health (Cancer Care Ontario) to provide guidance for managing surveillance of patients with stage I, II, III, or resectable IV melanoma who are clinically disease-free after treatment with curative intent (following the definition of American Joint Committee on Cancer  Pathological Prognostic Stage Groups in the 2017 Cancer Staging Manual, the 8 th edition).

# TARGET POPULATION
These recommendations apply to patients with stage I, II, III, or resectable IV melanoma who are clinically disease-free after treatment with curative intent. Pathological staging is according to the 8 th edition AJCC staging system (Appendix 1).

# INTENDED USERS
Intended users of this guideline are medical oncologists, dermatologists, surgical oncologists, radiation oncologists, family doctors, and other clinicians who are involved in the follow-up care of patients with melanoma in the province of Ontario.

# RECOMMENDATIONS, KEY EVIDENCE, AND JUSTIFICATION
The strength of recommendations for this guideline includes three categories: Recommendation, Weak Recommendation, and No Recommendation (definitions and corresponding verb wording are provided in Appendix 2).

# Recommendation 1
For patients with stage IA, IB, or IIA melanoma who are clinically disease-free after receiving curative-intent treatment: 1.1 Clinical follow-up with history and physical examination with full skin and lymph node examination by a dermatologist (with photo-surveillance and dermoscopy if indicated), and/or a surgeon, family physician, cancer nurse specialists should occur every six to 12 months for three years, then annually for two years or as clinically indicated. 

# Recommendation 3
For patients with stage IIIA, IIIB, IIIC, IIID, or resected IV melanoma: 3.1 Clinical follow-up with history and physical examination with full skin and lymph node examination by a dermatologist (with photo-surveillance and dermoscopy if indicated), and/or a surgeon, medical oncologist, or cancer nurse specialist should occur every three to six months in years 1 to 3, then every six months in years 4 to 5, or as clinically indicated.
 3.2 Routine biomarker or blood tests to screen for asymptomatic recurrence or metastatic disease are not recommended.  3.3 CT or PET/CT scans every six to 12 months should be considered to screen for asymptomatic recurrence or metastatic disease in years 1 to 3, then annually in years 4 to 5.
 3.4 Annual brain MRI can be considered for years 1 to 5. MRI (no radiation) of the brain is preferred for routine screening where available, otherwise, head CT may be considered after discussing with patients.  3.5 For patients with a positive sentinel lymph node, ultrasound scans of the draining nodal basin should be done every four to six months for years 1 to 3, and then every six months for years 4 to 5, if no complete lymph node dissection is performed.
Peer review publication.

# TARGET POPULATION
- Patients of any age diagnosed with localized Ewing's sarcoma of bone who have completed neoadjuvant chemotherapy for the first objective - Patients of any age diagnosed with localized Ewing's sarcoma of bone who will undergo surgical management following neoadjuvant chemotherapy for the second objective

# INTENDED USERS
General surgeons, orthopaedic oncology surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, and other clinicians who are involved in the treatment of the target patients in the province of Ontario.

# RECOMMENDATIONS Recommendation 1
In patients with localized Ewing's sarcoma of bone following neoadjuvant chemotherapy:
- Either surgery alone or RT alone is a reasonable treatment option; the combination of surgery plus RT is not recommended as an initial treatment option. - The local treatment for an individual patient should be decided by a multidisciplinary tumour board together with the patient after consideration of the following: 1) patient characteristics (e.g., age, tumour location, tumour size, response to neoadjuvant chemotherapy, and existing comorbidities), 2) the potential benefit compared with the potential complications from surgery and/or toxicities associated with RT, and 3) patient preference.

# Qualifying Statements for Recommendation 1
- If complete tumour resection is impossible, RT alone may be the optimal choice.
- RT may be a treatment option postoperatively in patients who have residual tumours or positive margins.
- The optimal RT dose has not been determined. The reported RT doses in this document ranged from 55 to 60 Gray for RT alone (except one study published in 1999) and from 35 to 60 Gray for RT as an adjuvant to surgery.

# Added to the 2022 Endorsement:
- One retrospective data analysis of patients in the Euro-EWING99 trial treated with induction chemotherapy reported that a combination of RT and surgery decreased local recurrence more than RT alone in patients with non-sacral tumours of the pelvis. This evidence requires corroboration from further studies to warrant a review of or change to the current recommendation. See Section 6 for details.

# Recommendation 2
In patients with localized Ewing's sarcoma who will undergo surgery:
- Both pre-chemotherapy and post-chemotherapy MRI scans should be taken into consideration for surgical planning. In certain anatomic locations with good chemotherapy response, the post-chemotherapy MRI may be the appropriate imaging modality to plan surgical resection margins.
Is there a role for high dose rate endobronchial brachytherapy (HDREB) in the palliation of respiratory symptoms in patients with non-small cell lung cancer? 2.
If so, what is the optimal dose of HDREB in this setting?

# Target Population
The recommendations apply to adult patients with symptomatic endobronchial disease in non-small cell lung cancer.
- For patients with previously untreated, symptomatic, endobronchial non-small cell lung cancer: o External beam radiation therapy (EBRT) alone is more effective for palliation of respiratory symptoms than HDREB alone. June 2018: "Respiratory symptoms" is indicated in the research question and systematic review, and has been added here for clarification.
- The evidence does not provide conclusive results to suggest that routine use of HDREB and EBRT would provide improved symptom relief over EBRT alone.
June 2018: It is the opinion of the Lung Cancer Disease Site Group that HDREB and EBRT might be suitable in selected patients. o December 2022: the recommendation "For patients with complete collapse of the lung due to endobronchial obstruction, a surgical core out procedure may be needed before EBRT or EBRT with HDREB" is no longer endorsed because the updated evidence does not show a benefit of this procedure (See Section 4 for details). - For patients previously treated by EBRT who are symptomatic with endobronchial obstruction due to recurrent disease, HDREB is recommended, providing that endobronchial brachytherapy is technically feasible.

# Related Evidence Summary
- Evidence Summary Report #7-15: The Role of Photodynamic Therapy (PDT) in Patients with Non-small Cell Lung Cancer.
The PEBC is supported by Cancer Care Ontario (CCO) and the Ontario Ministry of Health and Long-Term Care. All work produced by the PEBC is editorially independent from its funding agencies.
Copyright This guideline is copyrighted by Cancer Care Ontario; the guideline and the illustrations herein may not be reproduced without the express written permission of Cancer Care Ontario. Cancer Care Ontario reserves the right at any time, and at its sole discretion, to change or revoke this authorization.
# TARGET POPULATION
Adult and paediatric patients who have received an allogeneic transplant and are experiencing graft-versus-host disease.

# RECOMMENDATIONS AND JUSTIFICATION

# Extra-corporeal Photopheresis (ECP) in the Management of Graft-Versus-Host Disease (GVHD)
- ECP is an acceptable therapy for the treatment of steroid-dependent / refractory acute GVHD in adult and paediatric patients Justification:
Three non-comparative studies in adult patients and six studies in paediatric patients  reported response rates in favour of the ECP ranging from 32% to 100%. Only one of the paediatric studies reported comparable response rates between patients who received ECP and patients who remained on conventional treatment (6).
In the opinion of the Expert Panel, although the quality of the data for steroid refractory aGVHD is limited, patients with primarily refractory skin GVHD should be considered for ECP treatment.
- ECP is an effective therapy for the treatment of steroid-dependent / refractory chronic GVHD in adult and paediatric patients
This recommendation is supported by the evidence obtained from two studies because in both studies, significant increase in response rates favour the ECP over conventional corticosteroid treatment. Five additional comparative studies (3,4,(11)(12)(13)) and six non-comparative studies (2,5,7,8,14,15) reported response rates ranging from 50% to 80%.

# QUALIFYING STATEMENTS
- ECP is currently a covered therapy in Ontario for patients with steroid refractory GVHD who meet certain eligibility criteria
The PEBC is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health and Long-Term Care. All work produced by the PEBC is editorially independent from the Ontario Ministry of Health and Long-Term Care.
Updating All PEBC documents are maintained and updated as described in the PEBC Document Assessment and Review Protocol.
# Section 1:
Recommendations Summary ................................................... 1 Section 2:
Guideline ....................................................................................... 3 Section 3: Section 4: Section 5: Guideline Methods Overview ................................................... 9 Evidence Review.......................................................................... 12 Internal and External Review ................................................ 56
For information about this document, please contact Dr. Roanne Segal, the lead author, through the PEBC via: Phone: 905-527-4322 ext. 42822 Fax: 905-526-6775 E-mail: ccopgi@mcmaster.ca For information about the PEBC and the most current version of all reports, please visit the CCO website at / or contact the PEBC office at:
Phone: 905-527-4322 ext. Copyright This report is copyrighted by Cancer Care Ontario; the report and the illustrations herein may not be reproduced without the express written permission of Cancer Care Ontario. Cancer Care Ontario reserves the right at any time, and at its sole discretion, to change or revoke this authorization.
Questions JUDGEMENTS The GDG considered this topic a low priority for health economic analysis.
The Working Group members agreed that the feasibility of PCI for this population has been well established.

# Appendix 1: Affiliations and Conflict of Interest Declarations
In accordance with the PEBC Conflict of Interest Policy, the Members of the Prophylactic cranial irradiation for SCLC GDG Working Group, Expert Panel, and Report Approval Panel were asked to disclose potential conflicts of interest.
For information about this document, please contact Dr. Eric Winquist, the lead author, through the PEBC via: Phone: 905-527-4322 ext. 42822 Fax: 905 526-6775 E-mail: ccopgi@mcmaster.ca
For information about the PEBC and the most current version of all reports, please visit the CCO website at / or contact the PEBC office at: Phone: 905-527-4322 ext. 42822 Fax: 905 526-6775 E-mail: ccopgi@mcmaster.ca 

# PUBLICATIONS RELATED TO THIS REPORT
The evidence review has been published as a Supplement Copyright This report is copyrighted by Cancer Care Ontario; the report and the illustrations herein may not be reproduced without the express written permission of Cancer Care Ontario. Cancer Care Ontario reserves the right at any time, and at its sole discretion, to change or revoke this authorization.
# Injury claims
All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide (PPSV23) and zoster (RZV, ZVL) vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a vaccine injury claim is available at www.hrsa.gov/vaccinecompensation.

# Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC- , in English or Spanish, 8 a.m.-8 p.m. ET, Monday through Friday, excluding holidays. 3 Review vaccine types, frequencies, and intervals and considerations for special situations (Notes)

# Helpful information
Recommended by the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/acip) and approved by the Centers for Disease Control and Prevention (www.cdc.gov), American College of Physicians (www.acponline.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org).

# UNITED STATES 2020
Vaccines in the Adult Immunization Schedule*

# Human papillomavirus vaccination

# Routine vaccination
y HPV vaccination recommended for all adults through age 26 years: 2-or 3-dose series depending on age at initial vaccination or condition:
-Age 15 years or older at initial vaccination: 3-dose series at 0, 1-2, 6 months (minimum intervals: 4 weeks between doses 1 and 2/12 weeks between doses 2 and 3/5 months between doses 1 and 3; repeat dose if administered too soon) -Age 9 through 14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 dose -Age 9 through 14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination complete, no additional dose needed. -Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart for measles or mumps or at least 1 dose for rubella -Born before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for measles or mumps or 1 dose for rubella
data are insufficient to recommend use of the FDA-approved single-use rapid HIV-1/HIV-2 antigen/antibody combination immunoassay as the initial assay in the algorithm.# Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens
1. Laboratories should conduct initial testing for HIV with an FDA-approved antigen/antibody combination immunoassay- that detects HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen to screen for established infection with HIV-1 or HIV-2 and for acute HIV-1 infection. No further testing is required for specimens that are nonreactive on the initial immunoassay.
2. Specimens with a reactive antigen/antibody combination immunoassay result (or repeatedly reactive, if repeat testing is recommended by the manufacturer or required by regulatory authorities) should be tested with an FDA-approved antibody immunoassay that differentiates HIV-1 antibodies from HIV-2 antibodies. Reactive results on the initial antigen/antibody combination immunoassay and the HIV-1/HIV-2 antibody differentiation immunoassay should be interpreted as positive for HIV-1 antibodies, HIV-2 antibodies, or HIV antibodies, undifferentiated.
3. Specimens that are reactive on the initial antigen/antibody combination immunoassay and nonreactive or indeterminate on the HIV-1/HIV-2 antibody differentiation immunoassay should be tested with an FDA-approved HIV-1 nucleic acid test (NAT).
- A reactive HIV-1 NAT result and nonreactive HIV-1/HIV-2 antibody differentiation immunoassay result indicates laboratory evidence for acute HIV-1 infection.
- A reactive HIV-1 NAT result and indeterminate HIV-1/HIV-2 antibody differentiation immunoassay result indicates the presence of HIV-1 infection confirmed by HIV-1 NAT.
- A negative HIV-1 NAT result and nonreactive or indeterminate HIV-1/HIV-2 antibody differentiation immunoassay result indicates a false-positive result on the initial immunoassay.
4. Laboratories should use this same testing algorithm, beginning with an antigen/antibody combination immunoassay, with serum or plasma specimens submitted for testing after a reactive (preliminary positive) result from any rapid HIV test.