EAdjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update
EAdjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update
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DOI：
10.1200/jco.2017.72.4401
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发表时间：
2017-09-01
影响因子：
45.3
通讯作者：
Weyant, Michael
中科院分区：
文献类型：
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作者：
Kris, Mark G.;Gaspar, Laurie E.;Weyant, Michael
目的：该专家组更新了美国临床肿瘤学会（ASCO）关于非小细胞肺癌术后辅助治疗的指南。方法：ASCO召开了一个更新专家组，对文献进行了系统回顾，研究切除的非小细胞肺癌患者的辅助治疗，结果更新的证据基础涵盖了与辅助系统治疗相关的问题，并包括安大略癌症护理中心目前进行的系统评价到2016年1月最近的美国放射肿瘤学会指南和系统评价，以前由ASCO认可，被用作辅助放射治疗建议的基础。更新这些系统评价和搜索研究相关的放射治疗发现没有额外的随机对照试验。Recommendations辅助顺铂为基础的化疗是推荐用于例行使用的患者与阶段IIA，IIB，或IIIA疾病谁经历了完整的手术切除。对于IB期患者，不建议常规使用基于顺铂的辅助化疗。但是，建议进行术后多模式评估，包括咨询肿瘤科医生，以评估每位患者辅助化疗的获益和风险。该指南提供了在推荐辅助化疗时需要考虑的除分期以外的因素的信息，包括肿瘤大小、组织病理学特征和遗传改变。不建议IA期疾病患者进行辅助化疗。不建议对切除的I期或II期疾病患者进行辅助放射治疗。在IIIA期N2疾病患者中，不建议常规使用辅助放射治疗。然而，建议进行术后多模式评估，包括与放射肿瘤学家进行会诊，以评估每例N2疾病患者辅助放射治疗的获益和风险。(C)2017年美国临床肿瘤学会
Purpose The panel updated the American Society of Clinical Oncology (ASCO) adjuvant therapy guideline for resected non-small-cell lung cancers.Methods ASCO convened an update panel and conducted a systematic review of the literature, investigating adjuvant therapy in resected non-small-cell lung cancers.Results The updated evidence base covered questions related to adjuvant systemic therapy and included a systematic review conducted by Cancer Care Ontario current to January 2016. A recent American Society for Radiation Oncology guideline and systematic review, previously endorsed by ASCO, was used as the basis for recommendations for adjuvant radiation therapy. An update of these systematic reviews and a search for studies related to radiation therapy found no additional randomized controlled trials.Recommendations Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stage IIA, IIB, or IIIA disease who have undergone complete surgical resections. For individuals with stage IB, adjuvant cisplatin-based chemotherapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant chemotherapy for each patient. The guideline provides information on factors other than stage to consider when making a recommendation for adjuvant chemotherapy, including tumor size, histopathologic features, and genetic alterations. Adjuvant chemotherapy is not recommended for patients with stage IA disease. Adjuvant radiation therapy is not recommended for patients with resected stage I or II disease. In patients with stage IIIA N2 disease, adjuvant radiation therapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiation therapy for each patient with N2 disease. (C) 2017 by American Society of Clinical Oncology