title: [Standards, options and recommendations for the management of locally advanced non small cell lung carcinoma].
abstract: BACKGROUND
  The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
  
  
  OBJECTIVE
  To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of locally advanced non small cell lung carcinoma.
  
  
  METHODS
  Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 French Cancer Centres.
  
  
  RESULTS
  The main recommendations are: 1) The management of the locally advanced non small cell lung carcinoma has two main goals: firstly to obtain local control of the disease (or to at least delay local progression in order to improve the survival or relapse free survival), and secondly to prevent the development of metastases. 2) There is a consensus that locally advanced non small cell lung carcinoma should be irradiated. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poor life expectancy, this can be delivered as a split-course or hypofractionated scheme. 3) Treatment for patients with a performance status of 0-1 should consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional radiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combined radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside clinical trials. Surgery is justified in stage N2 disease as good local control can be achieved. T4-N0 disease should be treated surgically with curative intent.
authors.affiliation: Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13.
authors.forename: E
authors.initials: E
authors.lastname: Bardet
authors.forename: D
authors.initials: D
authors.lastname: Moro-Sibilot
authors.forename: T
authors.initials: T
authors.lastname: Le Chevalier
authors.forename: G
authors.initials: G
authors.lastname: Massard
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authors.initials: JY
authors.lastname: Douillard
authors.forename: S
authors.initials: S
authors.lastname: Theobald
authors.forename: P
authors.initials: P
authors.lastname: Astoul
authors.forename: P
authors.initials: P
authors.lastname: Baldeyrou
authors.forename: B
authors.initials: B
authors.lastname: Bazelly
authors.forename: J
authors.initials: J
authors.lastname: Bréchot
authors.forename: J L
authors.initials: JL
authors.lastname: Breton
authors.forename: P
authors.initials: P
authors.lastname: Grivaux
authors.forename: P
authors.initials: P
authors.lastname: Jacoulet
authors.forename: A
authors.initials: A
authors.lastname: Khalil
authors.forename: E
authors.initials: E
authors.lastname: Lemarie
authors.forename: Y
authors.initials: Y
authors.lastname: Martinet
authors.forename: B
authors.initials: B
authors.lastname: Milleron
authors.forename: M
authors.initials: M
authors.lastname: Paesmans
authors.forename: J L
authors.initials: JL
authors.lastname: Pujol
authors.forename: A E
authors.initials: AE
authors.lastname: Quoix
authors.forename: E
authors.initials: E
authors.lastname: Ranfaing
authors.forename: A
authors.initials: A
authors.lastname: Rivière
authors.forename: H
authors.initials: H
authors.lastname: Sancho-Garnier
authors.forename: P J
authors.initials: PJ
authors.lastname: Souquet
authors.forename: D
authors.initials: D
authors.lastname: Spaeth
authors.forename: A
authors.initials: A
authors.lastname: Stcebner-Delbarre
authors.forename: L
authors.initials: L
authors.lastname: Thiberville
authors.forename: E
authors.initials: E
authors.lastname: Touboul
authors.forename: F
authors.initials: F
authors.lastname: Vaylet
authors.forename: J M
authors.initials: JM
authors.lastname: Vergnon
authors.forename: V
authors.initials: V
authors.lastname: Westeel
authors.forename: A
authors.initials: A
authors.lastname: Depierre
authors.forename: J L
authors.initials: JL
authors.lastname: Lagrange
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic
chemical_list: D011838:Radiation-Sensitizing Agents; D002945:Cisplatin