Adjuvant Chemotherapy Changes in Lung Cancer Guidelines.

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Presented at NCCN

http://www.docguide.com/news/content.ns ... r&count=10

By Ed Susman

HOLLYWOOD, FL -- March 19, 2007 -- Chemotherapy should be offered to patients who have high-risk stage 1A or stage IB non-small-cell lung cancer even after surgical resection shows negative margins, researchers said here at the 12th annual National Comprehensive Cancer Network Conference (NCCN) on Clinical Practice Guidelines and Quality Cancer Care.

"For stage 1A non-small-cell lung cancer where margins are positive, chemotherapy has been added to the guidelines as a option after resection," said David Ettinger, MD, Alex Grass Professor of Oncology and professor of medicine, otolaryngology-head and neck surgery, obstetric and gynaecology and radiation oncology and molecular radiation sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

"We added chemotherapy, based on category 1 evidence, which means there is convincing data for that recommendation," Dr. Ettinger said in reporting the guideline changes on March 15th.

For Stage 1A lung cancer in which the surgical margins are positive, Dr. Ettinger said that chemoradiation could also be offered, but the evidence for that recommendation is category 2B, meaning there was some disagreement with the recommendation among panel members from the 20 institutions that make up the NCCN.

Similarly, a category 2B recommendation was made for chemotherapy for Stage 1B patients who undergo surgery and have negative margins. Observation of these patients is also considered a possibility, he said.

The doctors removed the category 2B notation for the recommendation that patients with stage 1 lung cancer undergo photon emission tomography scans to determine if there is residual or metastatic cancer. Removal of the category 2b notation indicates that the level of evidence is category 2A, meaning lower-level evidence supports the recommendation and there is agreement among the panelists.

For patients with more advanced, T3N2M1 negative non-small-cell lung cancer, the panel said that patients should be given a treatment option in which surgical resection of the remaining tumour should be considered if the patient had an excellent response to definitive chemoradiation, Dr. Ettinger said.