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. Additional information is available at www.asco.org/
lung-cancer-guidelines and www.asco.org/guidelineswiki .