Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)60737-6.pdf

Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial

Neuroendocrine tumors account for approximately 20% of lung cancers; most (≈15%) are small cell lung cancer (SCLC). These NCCN Clinical Practice Guidelines in Oncology for SCLC focus on extensive-stage SCLC because it occurs more frequently than limited-stage disease. SCLC is highly sensitive to initial therapy; however, most patients eventually die of recurrent disease. In patients with extensive-stage disease, chemotherapy alone can palliate symptoms and prolong survival in most patients; however, long-term survival is rare. Most cases of SCLC are attributable to cigarette smoking; therefore, smoking cessation should be strongly promoted.

/pdf/non-small-cell-lung-cancer-clinical-practice-guidelines-in-3alu4woroj.pdf

Non-small cell lung cancer: Clinical practice guidelines in oncology

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

https://erj.ersjournals.com/content/erj/34/1/17.full.pdf

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

In 2010, approximately 222,520 new cases of lung or bronchial cancer will be diagnosed in the USA, and 157,300 patients are expected to die of this disease [1]. Lung cancer is the leading cause of cancer-related death in both men and women, and non-small cell lung cancer (NSCLC) accounts for about 80 % of these cases. Lung cancer is most often asymptomatic in its early stages; consequently, the disease is usually diagnosed at an advanced stage, when it is much more difficult to treat. One or more genes are believed to be responsible for an inherited increase in risk of developing lung cancer in the general population. Smoking remains one of the main environmental factors associated with the development of lung cancer [2]. Although the development of lung cancer seems to be the result of several sequential molecular abnormalities in individuals at high risk of developing the disease, the genetic mechanisms by which an individual develops lung cancer remain largely unknown. These steps involve abnormalities in the expression of angiogenic factors (e.g., vascular endothelial growth factor, or VEGF and epithelial growth factor receptors, or EGFRs) [3]. The heterogeneity of lung cancer and the diversity of its morphologic appearance and molecular properties make the application of molecular targeted therapies used in other cancers more complex, but such therapies are certainly a goal for the future.

Non–Small Cell Lung Cancer

Background : Induction chemotherapy before surgical resection increases survival compared with surgical resection alone in patients with stage IIIA-N2 non–small-cell lung cancer (NSCLC). We hypothesized that, following a response to induction chemotherapy, surgical resection would be superior to thoracic radiotherapy as locoregional therapy. Methods : Selected patients with histologic or cytologic proven stage IIIA-N2 NSCLC were given three cycles of platinum- based induction chemotherapy. Responding patients were subsequently randomly assigned to surgical resection or radiotherapy. Survival curves were estimated using Kaplan–Meier analyses from time of randomization. Results : Induction chemotherapy resulted in a response rate of 61% (95% confidence interval [CI] = 57% to 65%) among the 579 eligible patients. A total of 167 patients were allocated to resection and 165 to radiotherapy. Of the 154 (92%) patients who underwent surgery, 14% had an exploratory thoracotomy, 50% a radical resection, 42% a pathologic downstaging, and 5% a pathologic complete response; 4% died after surgery. Postoperative radiotherapy was administered to 62 (40%) of patients in the surgery arm. Among the 154 (93%) irradiated patients, overall compliance to the radiotherapy prescription was 55%, and grade 3/4 acute and late esophageal and pulmonary toxic effects occurred in 4% and 7%; one patient died of radiation pneumonitis. Median and 5-year overall survival for patients randomly assigned to resection versus radiotherapy were 16.4 versus 17.5 months and 15.7% versus 14%, respectively (hazard ratio = 1.06, 95% CI = 0.84 to 1.35). Rates of progression-free survival were also similar in both groups. Conclusion : In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared with radiother- apy. In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.

https://www.jto.org/article/S1556-0864(15)31295-8/pdf

Randomized Controlled Trial of Resection Versus Radiotherapy After Induction Chemotherapy in Stage IIIA-N2 Non–Small-Cell Lung Cancer

O-147 Surgery after induction chemotherapy: Morbidity and mortality in the first 100 patients of the surgery arm of EORTC 08941 trial

Induction chemotherapy (CT) in stage IIIA-N2 non-small cell lung cancer (NSCLC): An analysis of different regimens used in EORTC 08941

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Randomized Controlled Trial of Resection Versus Radiotherapy After Induction Chemotherapy in Stage IIIA-N2 Non–Small-Cell Lung Cancer

O-147 Surgery after induction chemotherapy: Morbidity and mortality in the first 100 patients of the surgery arm of EORTC 08941 trial

Induction chemotherapy (CT) in stage IIIA-N2 non-small cell lung cancer (NSCLC): An analysis of different regimens used in EORTC 08941