This is the current release of the guideline.

This guideline updates previous versions:

• Smythe WR. Treatment of stage I non-small cell lung carcinoma. Chest 2003 Jan;123(1 Suppl):181S-7S.
• Scott WJ, Howington J, Movsas B. Treatment of stage II non-small cell lung cancer. Chest 2003 Jan;123(1 Suppl):188S-201S.

Definitions for the strength of evidence and recommendation grades (1A-2C) follow the recommendations.

1. For patients with clinical stage I and II non-small cell lung cancer (NSCLC) and no medical contraindication to operative intervention, surgical resection is recommended. Grade of recommendation, 1A
2. For patients with clinical stage I and II NSCLC, it is recommended that they be evaluated by a thoracic surgical oncologist with a prominent part of his/her practice focused on lung cancer, even if they are being considered for nonsurgical therapies such as percutaneous ablation or stereotactic body radiation therapy (SBRT). Grade of recommendation, 1B
3. In patients with stage I and II NSCLC who are medically fit for conventional surgical resection, lobectomy or greater resection are recommended rather than sublobar resections (wedge or segmentectomy). Grade of recommendation, 1A
4. In patients with stage I NSCLC who may tolerate operative intervention but not a lobar or greater lung resection due to comorbid disease or decreased pulmonary function, sublobar resection is recommended over nonsurgical interventions. Grade of recommendation, 1B
5. In patients with stage I NSCLC who are considered appropriate candidates for thoracoscopic anatomic lung resection (lobectomy or segmentectomy), the use of video-assisted thoracic surgery (VATS) by surgeons experienced in these techniques is an acceptable alternative to open thoracotomy. Grade of recommendation, 1B
6. In patients undergoing resection for stage I and II NSCLC, it is recommended that intraoperative systematic mediastinal lymph node sampling or dissection be performed for accurate pathologic staging. Grade of recommendation, 1B
7. For patients with centrally or locally advanced NSCLC in whom a complete resection can be achieved with either technique, sleeve lobectomy is recommended over pneumonectomy. Grade of recommendation, 1B
8. For patients with N1 lymph node metastases (stage II NSCLC) in whom a complete resection can be achieved with either technique, sleeve lobectomy is recommended over pneumonectomy. Grade of recommendation, 1B
9. For patients with completely resected stage IA NSCLC, the use of adjuvant chemotherapy is not recommended for routine use outside the setting of a clinical trial. Grade of recommendation, 1A
10. For patients with completely resected stage IB NSCLC, the use of adjuvant chemotherapy is not recommended for routine use. Grade of recommendation, 1B
11. For patients with completely resected stage II NSCLC and good performance status, the use of platinum-based adjuvant chemotherapy is recommended. Grade of recommendation, 1A
12. For patients with stage I or II NSCLC who are not candidates for surgery ("medically inoperable") or who refuse surgery, curative intent fractionated radiotherapy is recommended. Grade of recommendation, 1B
13. For patients with completely resected stage IA or IB NSCLC, postoperative radiotherapy is associated with a decreased survival and is not recommended. Grade of recommendation, 1B
14. For patients with completely resected stage II NSCLC, postoperative radio-therapy decreases local recurrence but a survival benefit has not been clearly shown; therefore, postoperative radiotherapy is not recommended. Grade of recommendation, 1B

Definitions:

Quality of Evidence Scale

High - Randomized controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies*

Moderate - RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies*

Low or very low - Observational studies or case series

*Although the determination of magnitude of the effect based on observational studies is often a matter of judgment, the guideline developers offer the following suggested rule to assist this decision: a large effect would be a relative risk > 2 (risk ratio < 0.5) [which would justify moving from weak to moderate], and a very large effect is a relative risk > 5 (risk ratio < 0.2) [which would justify moving from weak to strong]. There is some theoretical justification in the statistical literature for these thresholds (the magnitude of effect that is unlikely or very unlikely to be due to residual confounding after adjusted analysis). However, once the decision is made, authors should be explicit in justifying their decisions.

Grade of Recommendations Scale

Relationship of Strength of the Supporting Evidence to the Balance of Benefits to Risks and Burdens

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 Jan (revised 2007 Sep)

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on Lung Cancer Guidelines

Primary Authors: Walter J. Scott, MD, FCCP; John Howington, MD, FCCP; Steven Feigenberg, MD; Benjamin Movsas, MD; Katherine Pisters, MD

American Association for Bronchology - Disease Specific Society
American Association for Thoracic Surgery - Medical Specialty Society
American College of Surgeons - Medical Specialty Society
American Society for Therapeutic Radiology and Oncology
Asian Pacific Society of Respirology - Disease Specific Society
Oncology Nursing Society - Professional Association
Society of Thoracic Surgeons - Medical Specialty Society
World Association of Bronchology - Disease Specific Society

This is the current release of the guideline.

This guideline updates previous versions:

• Smythe WR. Treatment of stage I non-small cell lung carcinoma. Chest 2003 Jan;123(1 Suppl):181S-7S.
• Scott WJ, Howington J, Movsas B. Treatment of stage II non-small cell lung cancer. Chest 2003 Jan;123(1 Suppl):188S-201S.

This NGC summary was completed by ECRI on July 22, 2003. The information was verified by the guideline developer on August 18, 2003. The updated information was verified by the guideline developer on December 21, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.