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Lung Cancer

Consensus Conference: Multimodality Management of Early- and Intermediate-Stage Non-Small Cell Lung Cancer

Georgia Cancer Specialists, Atlanta, Georgia, USA

Key Words. Non-small cell carcinoma • Thoracic surgery • Adjuvant radiotherapy • Adjuvant chemotherapy • Consensus development conference

Correspondence: Rodolfo Bordoni, M.D., Georgia Cancer Specialists, 340 Kennestone Hospital Boulevard, Suite 100, Marietta, Georgia 30060, USA; Telephone: 770-590-8311; Fax: 770-590-8313; e-mail: Rodolfo.bordoni{at}gacancer.com

Received March 12, 2008; accepted for publication July 21, 2008; first published online in THE ONCOLOGIST Express on September 8, 2008.

Disclosure: Employment/leadership position: None; Intellectual property rights/inventor/patent holder: None; Consultant/advisory role: None; Honoraria: None; Research funding: None; Ownership interest: None; Expert testimony: None; Other: Speakers' bureau: Rodolfo Bordoni, AstraZeneca, Eli Lilly, Novartis. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the author, planners, independent peer reviewers, or staff managers.Disclosure of potential conflicts of interest of panel members: Consultant/advisory role: Julie Brahmer, Cephalon, Eli Lilly; Fadlo Khuri, Amgen, Ligand Pharmaceuticals; Eric Vallières, Genentech BioOncology, OSI Pharmaceuticals, Sanofi-Aventis; Honoraria: Julie Brahmer, Genentech BioOncology, OSI Pharmaceuticals; Grants/research support: Julie Brahmer, AstraZeneca, Medarex, Pfizer, Wyeth; Fadlo Khuri, Genentech BioOncology, Novartis, Sanofi-Aventis; Edward Kim, Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, Genentech BioOncology, ImClone, Sanofi-Aventis; Katherine Pisters, Eli Lilly; Ownership interest: None; Expert testimony: None; Speakers' bureau: Thomas D'Amico, United States Surgical Corporation; Fadlo Khuri, Genentech BioOncology, Sanofi-Aventis; Edward Kim, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Genentech BioOncology, ImClone, Sanofi-Aventis; Eric Vallières, Sanofi-Aventis.

Surgery is the mainstay of treatment in early- and intermediate-stage non-small cell lung cancer (NSCLC), yet recurrences are frequent. Studies have documented the benefits of chemotherapy administered after resection, but a number of questions remain regarding how overall outcomes can be further improved. To provide the oncology community with direction on these issues, a consensus conference of leading experts in the NSCLC field was held at the Fifth Annual Atlanta Lung Cancer Symposium on October 25–27, 2007.

The available scientific literature is presented and when such literature is lacking, clinical experience is provided to support the following conclusions. Preoperative staging should be done in accordance with the National Comprehensive Cancer Network guidelines, but endoscopic fine needle aspiration of enlarged mediastinal nodes can be used, and if histology is positive for malignancy, mediastinoscopy can be avoided. Neoadjuvant systemic therapy is not generally recommended but can be considered to downstage an unresectable patient. There is currently no role for preoperative radiation or chemoradiation. Adjuvant systemic therapy is not recommended for stage IA and IB patients; however, adverse prognostic factors are acceptable reasons to consider adjuvant systemic therapy in the latter. Adjuvant systemic therapy is recommended for stage IIA, IIB, and IIIA patients, consistent with recent American Society of Clinical Oncology guidelines. A cisplatin-based regimen should be started within 60 days after surgery, but if relatively contraindicated, carboplatin is an acceptable alternative. Adjuvant radiation therapy is not recommended for N0 and N1 patients, but is used in N2 patients to decrease local recurrence.