Management of Stage III Non–Small-Cell Lung Cancer: ASCO Guideline

Daly, Megan E.; Singh, Navneet; Ismaila, Nofisat; Antonoff, Mara B.; Arenberg, Douglas A.; Bradley, Jeffrey D.; David, Elizabeth A.; Detterbeck, Frank C.; Früh, Martin; Gubens, Matthew A.; Moore, Amy; Padda, Sukhmani K.; Patel, Jyoti D.; Phillips, Tanyanika; Qin, Angel; Robinson, C.G.; Simone, Charles B.

doi:10.1200/jco.21.02528

Cited by 147 publications

(126 citation statements)

References 204 publications

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“…The updated ESMO Clinical Practice Guidelines see no benefit of PORT for patients with completely resected stage III N2 NSCLC and recommend PORT only in the setting of residual microscopic or macroscopic disease [ 11 ]. The recently published ASCO guidelines do not recommend PORT for patients with completely resected NSCLC with mediastinal N2 involvement without extracapsular extension who have received neoadjuvant or adjuvant platinum-based chemotherapy [ 47 ].…”

Section: Port After Complete Resectionmentioning

confidence: 99%

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer—A Review

Süveg

Plaßwilm

Iseli

et al. 2022

Cancers

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Background: For patients with completely resected non-small cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (pN2), the administration of adjuvant chemotherapy is the standard of care. The role of postoperative radiation therapy (PORT) is controversial. Methods: We describe the current literature focusing on the role of PORT in completely resected NSCLC patients with pN2 involvement and reflect on its role in current guidelines. Results: Based on the results of the recent Lung ART and PORT-C trials, the authors conclude that PORT cannot be generally recommended for all resected pN2 NSCLC patients. A substantial decrease in the locoregional relapse rate without translating into a survival benefit suggests that some patients with risk factors might benefit from PORT. This must be balanced against the risk of cardiopulmonary toxicity with potentially associated mortality. Lung ART has already changed the decision making for the use of PORT in daily practice for many European lung cancer experts, with lower rates of recommendations for PORT overall. Conclusions: PORT is still used, albeit decreasingly, for completely resected NSCLC with pN2 involvement. High-level evidence for its routine use is lacking. Further analyses are required to identify patients who would potentially benefit from PORT.

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Section: Port After Complete Resectionmentioning

confidence: 99%

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer—A Review

Süveg

Plaßwilm

Iseli

et al. 2022

Cancers

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“…The importance of imaging is then, in selecting the biopsy site, to confirm the highest possible disease stage and to maximize tissue yield. 14…”

Section: Nodal Classificationmentioning

confidence: 99%

“…47 48 49 Consequently, brain imaging with contrast-enhanced MRI scan (a contrast-enhanced head CT scan may be substituted if MRI is contraindicated) is recommended to exclude clinically silent CNS metastases in patients with clinical stage-III lung cancer. 14…”

Section: Metastasis Classificationmentioning

confidence: 99%

Imaging of Lung Cancer Staging

Archer

Truong

Shroff

et al. 2022

Semin Respir Crit Care Med

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Lung cancer is a leading cause of cancer-related mortality worldwide. Imaging is integral in accurate clinical staging to stratify patients into groups to predict survival and determine treatment. The eighth edition of the tumor, node, and metastasis (TNM-8) staging system proposed by the International Association for the Study of Lung Cancer in 2016, accepted by both the Union for International Cancer Control and the American Joint Committee on Cancer, is the current standard method of staging lung cancer. This single TNM staging is used for all histologic subtypes of lung cancer, including nonsmall cell lung cancer, small cell lung cancer, and bronchopulmonary carcinoid tumor, and it addresses both clinical and pathologic staging. Familiarity with the strengths and limitations of imaging modalities used in staging, the nuances of TNM-8, its correct nomenclature, and potential pitfalls are important to optimize patient care. In this article, we discuss the role of computed tomography (CT) and positron emission tomography/CT in lung cancer staging, as well as current imaging recommendations pertaining to TNM-8.

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“…Radiotherapy, together with the radio-sensitizing effect of chemotherapy, results in enhanced anti-tumor efficacy, although at the expense of significant normal tissue toxicity. Radiotherapy-induced lung injury (known as radiation pneumonitis in an early phase and pulmonary fibrosis in the late phase), as well as esophagitis are common adverse events following thoracic radiation ( 4 , 5 ). There are considerable variations between patients in their likelihood to develop severe adverse events following a given dose of radiation, which consequently, limits the maximum dose that can be administered to the majority ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Genomic Profiling Reveals Novel Predictive Biomarkers for Chemo-Radiotherapy Efficacy and Thoracic Toxicity in Non-Small-Cell Lung Cancer

Zhang²,

Pang³

et al. 2022

Front. Oncol.

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Chemo-radiotherapy (CRT) remains the main treatment modality for non-small-cell lung cancer (NSCLC). However, its clinical efficacy is largely limited by individual variations in radio-sensitivity and radiotherapy-associated toxicity. There is an urgent need to identify genetic determinants that can explain patients’ likelihood to develop recurrence and radiotherapy-associated toxicity following CRT. In this study, we performed comprehensive genomic profiling, using a 474-cancer- and radiotherapy-related gene panel, on pretreatment biopsy samples from patients with unresectable stage III NSCLCs who underwent definitive CRT. Patients’ baseline clinical characteristics and genomic features, including tumor genetic, genomic and molecular pathway alterations, as well as single nucleotide polymorphisms (SNPs), were correlated with progression-free survival (PFS), overall survival (OS), and radiotherapy-associated pneumonitis and/or esophagitis development after CRT. A total of 122 patients were enrolled between 2014 and 2019, with 84 (69%) squamous cell carcinomas and 38 (31%) adenocarcinomas. Genetic analysis confirmed the association between the KEAP1-NRF2 pathway gene alterations and unfavorable survival outcome, and revealed alterations in FGFR family genes, MET, PTEN, and NOTCH2 as potential novel and independent risk factors of poor post-CRT survival. Combined analysis of such alterations led to improved stratification of the risk populations. In addition, patients with EGFR activating mutations or any oncogenic driver mutations exhibited improved OS. On the other hand, we also identified genetic markers in relation to radiotherapy-associated thoracic toxicity. SNPs in the DNA repair-associated XRCC5 (rs3835) and XRCC1 (rs25487) were associated with an increased risk of high-grade esophagitis and pneumonitis respectively. MTHFR (rs1801133) and NQO1 (rs1800566) were additional risk alleles related to higher susceptibility to pneumonitis and esophagitis overall. Moreover, through their roles in genome integrity and replicative fidelity, somatic alterations in ZNF217 and POLD1 might also serve as risk predictors of high-grade pneumonitis and esophagitis. Taken together, leveraging targeted next-generating sequencing, we identified a set of novel clinically applicable biomarkers that might enable prediction of survival outcomes and risk of radiotherapy-associated thoracic toxicities. Our findings highlight the value of pre-treatment genetic testing to better inform CRT outcomes and clinical actions in stage III unresectable NSCLCs.

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Management of Stage III Non–Small-Cell Lung Cancer: ASCO Guideline

Cited by 147 publications

References 204 publications

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer—A Review

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer—A Review

Imaging of Lung Cancer Staging

Genomic Profiling Reveals Novel Predictive Biomarkers for Chemo-Radiotherapy Efficacy and Thoracic Toxicity in Non-Small-Cell Lung Cancer

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