title: 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.
abstract: OBJECTIVE
  To determine the role of adjuvant chemotherapy and radiation therapy in patients with completely resected stage IA-IIIA non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  The Cancer Care Ontario Program in Evidence-Based Care and the American Society of Clinical Oncology convened a Joint Expert Panel in August 2006 to review the evidence and draft recommendations for these therapies.
  
  
  RESULTS
  Available data support the use of adjuvant cisplatin-based chemotherapy in completely resected NSCLC; however, the strength of the data and consequent recommendations vary by disease stage. Adjuvant radiation therapy appears detrimental to survival in stages IB and II, with a possible modest benefit in stage IIIA.
  
  
  CONCLUSIONS
  Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stages IIA, IIB, and IIIA disease. Although there has been a statistically significant overall survival benefit seen in several randomized clinical trials (RCTs) enrolling a range of people with completely resected NSCLC, results of subset analyses for patient populations with stage IB disease were not significant, and adjuvant chemotherapy in stage IB disease is not currently recommended for routine use. To date, very few patients with stage IA NSCLC have been enrolled onto RCTs of adjuvant therapy; adjuvant chemotherapy is not recommended in these cases. Evidence from RCTs demonstrates a survival detriment for adjuvant radiotherapy with limited evidence for a reduction in local recurrence. Adjuvant radiation therapy appears detrimental to survival in stage IB and II, and may possibly confer a modest benefit in stage IIIA.
authors.affiliation: M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Katherine M W
authors.initials: KM
authors.lastname: Pisters
authors.forename: William K
authors.initials: WK
authors.lastname: Evans
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Azzoli
authors.forename: Mark G
authors.initials: MG
authors.lastname: Kris
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Smith
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Desch
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
authors.forename: Peter M
authors.initials: PM
authors.lastname: Ellis
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Gaspar
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.forename: David R
authors.initials: DR
authors.lastname: Spigel
authors.forename: John R
authors.initials: JR
authors.lastname: Strawn
authors.forename: Yee C
authors.initials: YC
authors.lastname: Ung
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant
chemical_list: D002945:Cisplatin