The American Society of Clinical Oncology and Cancer Care Ontario have published guidelines regarding the use of adjuvant (postsurgery) chemotherapy and adjuvant radiation therapy in patients with Stage I-IIIA non–small cell lung cancer that has been completely surgically removed. The guidelines were published in the Journal of Clinical Oncology.
Lung cancer remains the leading cause of cancer-related deaths worldwide. In the United States, non–small cell lung cancer (NSCLC) accounts for 75–80% of all lung cancers. Early NSCLC means that cancer has not spread to distant sites in the body.
Adjuvant therapy refers to treatment administered following surgery. It is used to kill cancer cells that may be remaining in the body following surgery. The precise role of adjuvant chemotherapy in early NSCLC has been controversial, as not all studies have indicated a positive impact from adjuvant chemotherapy in this stage of disease. As well, chemotherapy is associated with side effects that are difficult to tolerate for some patients. However, overall data have suggested an improved outcome with the use of adjuvant chemotherapy for early NSCLC.
To provide guidelines on the use of adjuvant therapy in patients with Stage I-IIIA NSCLC that has been completely surgically removed, a panel of experts was convened by the American Society of Clinical Oncology and Cancer Care Ontario. The panel reviewed the available evidence regarding the risks and benefits of adjuvant cisplatin-based chemotherapy and adjuvant radiation therapy.
The panel recommended the following:
- Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with Stage IIA, IIB, and IIIA NSCLC. Adjuvant chemotherapy is not recommended for patients with Stage IA NSCLC. The benefits of adjuvant chemotherapy in patients with Stage IB NSCLC are still uncertain, and the guidelines do not recommend routine use of adjuvant chemotherapy in this group.
- Studies of adjuvant radiation therapy suggest it may reduce survival among patients with Stage I or II NSCLC, and adjuvant radiation therapy is not recommended for these patients. There’s a possibility that radiation therapy provides modest benefits to patients with Stage IIIA NSCLC, but because of the current uncertainty adjuvant radiation therapy is not recommended for routine use in patients with Stage IIIA disease.
Patients with operable, Stage I-IIIA NSCLC may wish to discuss these guidelines with their physician. The guidelines note that treatment decisions still need to be based on consideration of a patient’s individual circumstances.
Reference: Pisters KMW, Evans WK, Azzoli CG et al. 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. Journal of Clinical Oncology. 2007;25:5506-5518.