Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stages I-IIIA Completely Resected Non-small Cell Lung Cancers

Based on guidelines from the American Society of Clinical Oncology and Cancer Care Ontario.

Strength

Evidence

Adjuvant Systemic Therapy

Stage IA

Strong recommendation

Intermediate quality evidence

Adjuvant chemotherapy is not recommended.

Stage IB

Moderate recommendation

Intermediate quality evidence

Adjuvant cisplatin-based chemotherapy is not recommended for routine use. A postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant chemotherapy for each patient. Factors other than tumor stage to consider when making a recommendation for adjuvant chemotherapy are outlined after the adjuvant systemic therapy section of this guideline.

Stages IIA/B and IIIA

Strong recommendation

High quality evidence

Adjuvant cisplatin-based chemotherapy is recommended.

Adjuvant Radiation Therapy

Stages IA/B and IIA/B

Strong recommendation

Intermediate quality evidence

Adjuvant radiation therapy is not recommended.

Stage IIIA (N2)

Moderate recommendation

Intermediate quality evidence

Adjuvant radiation therapy is not recommended for routine use. A postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiotherapy for each patient with N2 disease.

Literature

Original/Primary Reference

Kris MG, Gaspar LE, Chaft JE, et al. Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update. J Clin Oncol. 2017;35(25):2960-2974.

What do the ratings mean?

How strong is the ASCO and CCO's recommendation?

Strong recommendation

High confidence that recommendation reflects best practice, based on (1) strong evidence for true net effect (benefits > harms); (2) consistent results, with no or minor exceptions; (3) minor or no concerns about study quality; and/or (4) extent of panelists’ agreement.

Moderate recommendation

Moderate confidence that recommendation reflects best practice, based on (1) good evidence for true net effect (benefits > harms); (2) consistent results, with minor and/or few exceptions; (3) minor and/or few concerns about study quality; and/or (4) extent of panelists’ agreement.

Weak recommendation

Some confidence that recommendation offers the best current guidance for practice, based on (1) limited evidence for true net effect (benefits > harms); (2) consistent results, but with important exceptions; (3) concerns about study quality; and/or (4) extent of panelists’ agreement.

High quality evidence

High confidence that available evidence reflects true magnitude and direction of net effect (i.e., balance of benefits vs harms) and that further research is very unlikely to change either magnitude or direction of this net effect.

Intermediate quality evidence

Moderate confidence that available evidence reflects true magnitude and direction of net effect. Further research is unlikely to alter the direction of the net effect; however, it might alter the magnitude of the net effect.

Low quality evidence

Low confidence that available evidence reflects true magnitude and direction of the net effect. Further research may change either the magnitude and/or direction of this net effect.

Insufficient evidence

Evidence is insufficient to discern true magnitude and direction of net effect. Further research may better inform the topic. The use of the consensus opinion of experts is reasonable to inform outcomes related to the topic.