Felip, E.

Pavlidis, N.

Stahel, R. A.

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ESMO Minimum Clinical Recommendations for diagnosis,treatment and follow-up of non-small-cell lung cancer (NSCLC)Incidence. The crude incidence of lung cancer in the European Unionis 52.5/100 000 per year, the mortality 48.7/100 000 peryear. Among men the rates are 82.5 and 77.0/100 000 peryear, among women 23.9 and 22.3/100 000 per year,respectively. NSCLC accounts for 80% of all cases. About90% of lung cancer mortality among men (and 80% amongwomen) is attributable to smoking.Diagnosis. Pathological diagnosis should be made according to theWHO classification from a bronchoscopic, tru-cut or surgi-cal biopsy or fine needle aspiration.Staging and risk assessment. Complete history and physical examination, chest X-ray andCT scan of the chest and upper abdomen if local therapy isbeing considered. Neurologic history and examination (witha CT scan and/or MRI of the brain if results are abnormal).. Mediastinal lymph node biopsy for operable NSCLC if CTscan shows nodes >1 cm in shortest transverse axis.. PET scan if warranted in resectable patients.. Bone scintigraphy, in the presence of bone pain, elevatedserum calcium level, or elevated alkaline phosphatase level.. Biopsy (or MRI or PET scan) to rule out metastatic diseasein otherwise potentially resectable patients with an isolatedadrenal mass or liver lesion.. Patients with NSCLC shall be staged according to theTNM-2002 system and be grouped into the risk categoriesshown in Table 1.Treatment of stage I–II disease. Surgery remains the standard treatment of early stageNSCLC. Adjuvant chemotherapy should be considered [II,A]. Postoperative radiotherapy is not recommended [I, A].. Curative radiotherapy as a single modality can achieve a5-year survival rate of up to 40% in selected patients withclinical stage I disease, and should be considered in cases ofmedically inoperable stage I and II disease.Treatment of stage III disease. Preoperative chemotherapy is standard for resectable stageIIIA. In randomized trials the survival of stage IIIA patientswas significantly better with induction chemotherapy plussurgical resection than with resection alone [I, A].. Platinum-based chemotherapy and thoracic radiotherapy isthe standard treatment for locally advanced, unresectableStage IIIB NSCLC or medically inoperable stage IIIANSCLC [I, A].Treatment of stage IV disease. Platinum-based chemotherapy combined with vinorelbine,gemcitabine or taxanes prolongs survival, improves qualityof life, and controls symptoms in patients with goodperformance status [I, A].Second-line chemotherapy. Second-line chemotherapy (docetaxel, pemetrexate)improves disease-related symptoms and improves survivalin selected patients [II, B].Response evaluation. Response evaluation is mandatory after 2 or 3 cycles ofchemotherapy by repetition of the initial radiographic tests.Follow-up. The optimal approach to post-treatment management ofpatients with thoracic malignancies, including the role ofradiologic evaluation, is controversial. For patients treatedwith curative intent, a history and physical examinationshould be performed every 3 months during the first 2years, and every 6 months thereafter.Table 1.Occult carcinoma Tx N0 M0Stage 0 Tis N0 M0Stage IA T1 N0 M0Stage IB T2 N0 M0Stage IIA T1 N1 M0Stage IIB T2 N1 M0T3 N0 M0Stage IIIA T1, T2 N2 M0T3 N1, N2 M0Stage IIIB Any T N3 M0T4 Any N M0Stage IV Any T Any N M1Annals of Oncology 16 (Supplement 1): i28–i29, 2005doi:10.1093/annonc/mdi821q 2005 European Society for Medical OncologyNoteLevels of Evidence [I–V] and Grades of Recommendation[A–D] as used by the American Society of Clinical Oncologyare given in square brackets. Statements without grading wereconsidered justified standard clinical practice by the expertauthors and the ESMO faculty.Literature1. Greene FL, Balch CM, Fleming ID, et al. In AJCC (American JointCommittee on Cancer) (ed.): Cancer Staging Handbook: TNMClassification of Malignant Tumors, sixth edition. New York:Springer-Verlag 2002.2. Stewart LA, Pignon JP. Chemotherapy in non-small-cell lung cancer:a meta-analysis using updated data on individual patients from 52randomized clinical trials. Br Med J 1995; 311: 899–909.3. Rosell R, Go´mez-Codina J, Camps C et al. A randomized trial com-paring preoperative chemotherapy plus surgery with surgery alone inpatients with non-small-cell lung cancer. N Engl J Med 1994; 330:153–158.4. Sause WT, Scott C, Taylor S et al. Preliminary results of a phase IIItrial in regionally advanced unresectable non-small-cell lung cancer.J Natl Cancer Inst 1995; 87: 198–205.5. The International Adjuvant Lung Cancer Trial Collaborative Group,Arriagada R, Bergman B, Dunant A et al. Cisplatin-based adjuvantchemotherapy in patients with completely resected non-small-celllung cancer. N Engl J Med 2004; 350: 351–360.6. Fossella FV, DeVore R, Kerr RN et al. Randomized phase III trial ofdocetaxel versus vinorelbine or ifosfamide in patients with advancednon-small-cell lung cancer previously treated with platinum-contain-ing chemotherapy regimens. The TAX 320 Non-Small Cell LungCancer Study Group. J Clin Oncol 2000; 18: 2354–2362.7. Shepherd FA, Dancey J, Ramlau R et al. Prospective randomized trialof docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemother-apy. J Clin Oncol 2000; 18: 2095–2103.8. Hanna N, Shepherd FA, Fossella FV et al. Randomized phase III trialof pemetrexed versus docetaxel in patients with non-small-cell lungcancer previously treated with chemotherapy. J Clin Oncol 2004; 22:1589–1597.Coordinating authors for the ESMO Guidelines Task Force: E. Felip1,R. A. Stahel2 & N. Pavlidis31Invited author, Hospital Universitario Vall D’Hebron, Barcelona, Spain;2Assigned task force member, Division of Oncology, University Hospital,Ra¨mistr. 100, CH-8091 Zu¨rich, Switzerland; 3Assigned task forcemember, University of Ioannina, Dept. Medical Oncology, 45110Ioannina, GreeceApproved by the ESMO Guidelines Task Force: February 2002, lastupdate: December 2004.Correspondence to:ESMO Guidelines Task ForceESMO Head OfficeVia La Santa 7CH-6962 LuganoSwitzerlandi29

ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of non-small-cell lung cancer (NSCLC)

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