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.
Adjuvant Systemic Therapy
Stage IA
Adjuvant chemotherapy is not recommended.
Strong recommendation
Intermediate quality evidence
Stage IB
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.
Moderate recommendation
Intermediate quality evidence
Stages IIA/B and IIIA
Adjuvant cisplatin-based chemotherapy is recommended.
Strong recommendation
High quality evidence
Adjuvant Radiation Therapy
Stages IA/B and IIA/B
Adjuvant radiation therapy is not recommended.
Strong recommendation
Intermediate quality evidence
Stage IIIA (N2)
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.
Moderate recommendation
Intermediate quality evidence
What do the icons 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.
Literature
