title: ACR Appropriateness Criteria(®) induction and adjuvant therapy for N2 non-small-cell lung cancer.
abstract: The integration of chemotherapy, radiation therapy (RT), and surgery in the management of patients with stage IIIA (N2) non-small-cell lung carcinoma is challenging. The American College of Radiology (ACR) Appropriateness Criteria Lung Cancer Panel was charged to update management recommendations for this clinical scenario. The Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. There is limited level I evidence to guide patient selection for induction, postoperative RT (PORT), or definitive RT. Literature interpretation is complicated by inconsistent diagnostic procedures for N2 disease, disease heterogeneity, and pooled analysis with other stages. PORT is an appropriate therapy following adjuvant chemotherapy in patients with incidental pN2 disease. In patients with clinical N2 disease who are potential candidates for a lobectomy, both definitive and induction concurrent chemotherapy/RT are appropriate treatments. In N2 patients who require a pneumonectomy, definitive concurrent chemotherapy/RT is most appropriate although induction concurrent chemotherapy/RT may be considered in expert hands. Induction chemotherapy followed by surgery +/- PORT may also be an option in N2 patients. For preoperative RT and PORT, 3-dimensional conformal techniques and intensity-modulated RT are most appropriate.
authors: *Massachusetts General Hospital, Boston, MA †University of North Carolina Health Care System, American Society of Clinical Oncology, Chapel Hill, NC ‡Indiana University School of Medicine, Indianapolis, IN §Henry Ford Health System #Henry Ford Hospital, Detroit, MI ¶21st Century Oncology/Michigan Healthcare Professionals, Farmington Hills, MI ∥Society of Thoracic Surgeons, Columbia University, New York, NY ††Memorial Sloan Kettering Cancer Center, New York, NY ‡‡Mount Sinai School of Medicine, New York, NY **Stanford University and Stanford Cancer Institute, Stanford, CA §§Cleveland Clinic Foundation, Cleveland, OH ∥∥University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Henning
authors: H
authors: Willers
authors: Thomas E
authors: TE
authors: Stinchcombe
authors: R Bryan
authors: RB
authors: Barriger
authors: Indrin J
authors: IJ
authors: Chetty
authors: Mark E
authors: ME
authors: Ginsburg
authors: Larry L
authors: LL
authors: Kestin
authors: Sanath
authors: S
authors: Kumar
authors: Billy W
authors: BW
authors: Loo
authors: Benjamin
authors: B
authors: Movsas
authors: Andreas
authors: A
authors: Rimner
authors: Kenneth E
authors: KE
authors: Rosenzweig
authors: Gregory M M
authors: GM
authors: Videtic
authors: Joe Yujiao
authors: JY
authors: Chang
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents