Originally published as JCO Early Release 10.1200/JCO.2007.14.1226 on October 22 2007

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Cancer Care Ontario and American Society of Clinical Oncology Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non–Small-Cell Lung Cancer Guideline

Katherine M.W. Pisters, William K. Evans, Christopher G. Azzoli, Mark G. Kris, Christopher A. Smith, Christopher E. Desch, Mark R. Somerfield, Melissa C. Brouwers, Gail Darling, Peter M. Ellis, Laurie E. Gaspar, Harvey I. Pass, David R. Spigel, John R. Strawn, Yee C. Ung, Frances A. Shepherd

From the M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center; New York University School of Medicine, New York, NY; National Comprehensive Cancer Network, Jenkintown, PA; American Society of Clinical Oncology, Alexandria, VA; University of Colorado at Denver Health Sciences Center, Denver, CO; National Cancer Institute Cancer Center, Bethesda, MD; Sarah Cannon Cancer Center, Nashville, TN; Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton; Cancer Care Ontario; Toronto-Sunnybrook Regional Cancer Centre; and the University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
Deceased.

Address reprint requests to ASCO, Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

Purpose To determine the role of adjuvant chemotherapy and radiation therapy in patients with completely resected stage IA-IIIA non–small-cell lung cancer (NSCLC).

Methods The Cancer Care Ontario Program in Evidence-Based Care and the American Society of Clinical Oncology convened a Joint Expert Panel in August 2006 to review the evidence and draft recommendations for these therapies.

Results Available data support the use of adjuvant cisplatin-based chemotherapy in completely resected NSCLC; however, the strength of the data and consequent recommendations vary by disease stage. Adjuvant radiation therapy appears detrimental to survival in stages IB and II, with a possible modest benefit in stage IIIA.

Conclusion Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stages IIA, IIB, and IIIA disease. Although there has been a statistically significant overall survival benefit seen in several randomized clinical trials (RCTs) enrolling a range of people with completely resected NSCLC, results of subset analyses for patient populations with stage IB disease were not significant, and adjuvant chemotherapy in stage IB disease is not currently recommended for routine use. To date, very few patients with stage IA NSCLC have been enrolled onto RCTs of adjuvant therapy; adjuvant chemotherapy is not recommended in these cases. Evidence from RCTs demonstrates a survival detriment for adjuvant radiotherapy with limited evidence for a reduction in local recurrence. Adjuvant radiation therapy appears detrimental to survival in stage IB and II, and may possibly confer a modest benefit in stage IIIA.

published online ahead of print at www.jco.org on October 22, 2007.

This article is dedicated to Christopher E. Desch, MD, who was the National Medical Director of the National Comprehensive Cancer Network, one of the founding volunteers of the Quality Oncology Practice Initiative for ASCO, and a driving force behind ASCO oncology guidelines. As both an academic and community oncologist, he had a unique perspective, ability, and passion to improve the quality of cancer care.

Approved by the ASCO Board of Directors on August 15, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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