Summary Recommendations

Guideline Recommendations

1. Which patients are suitable?

1. The risks and benefits of postoperative systemic anticancer therapy should be discussed with each patient (GPP).

2. Patients with good performance status (PS 0-1) and completely resected pathological Stage II-III NSCLC with negative margins should be offered platinum based postoperative systemic anticancer therapy (A).

2. What regimen should be used?

Patients with completely resected stage II NSCLC should be offered 3-4 cycles of adjuvant cisplatin based chemotherapy (A).

Patients who have a good performance status (WHO 1, 2) and completely resected stage III non-small cell lung cancer should be offered adjuvant cisplatin-based chemotherapy (A).

3. What is the role of adjuvant chemotherapy in stage I?

1. Observation is recommended for patients with T1ab, N0 tumours with negative surgical margins (Category 2A).

2. Patients with T2ab, N0 tumours with negative surgical margins are usually observed (Category 2A).

3. Chemotherapy for high risk features (include poorly differentiated tumours, vascular invasion, wedge resection, >4cm, visceral pleural involvement, and incomplete LN sampling) (Category 2A).

4. What treatment options are available for positive margins?

1. Stage IA with R1 or R2: (1) re-resection (Category 2A) or (2) RT (Category 2B).

2. T2abN0: (1) re-resection +/- chemotherapy, (2) RT +/- chemotherapy (Category2A)

3. Stage II positive margins with R1: (1) re-resection and chemotherapy, (2) chemo-radiation (either sequential or concurrent), with R2: (1) re-resection and chemotherapy or (2) concurrent chemo-radiation (Category 2A).

4. T1-3, N2 or T3N1 with R1: Chemo-radiation (either sequential or concurrent), with R2: concurrent chemo-radiation (Category 2A).

5. What are the treatment options for pN2 disease with negative margins?

1. Patients who have a good performance status and completely resected stage III NSCLC should be offered adjuvant platinum-based chemotherapy (A).

2. PORT in patients with pN2 disease is not recommended for routine use because of the lack of prospective randomised clinical trial data demonstrating an improvement in survival. PORT could be considered in selected patients with pN2 disease (C).

LN, lymph node; NSCLC, non-small cell lung cancer; PORT, postoperative radiotherapy; WHO, World Health Organisation