Management of Patients with Early-Stage Non-Small Cell Lung Cancer: An American College of Chest Physicians Clinical Practice Guideline
Abstract
BACKGROUND
Lung cancer remains the number one cause of cancer death in men and women in the United States and much of the world. This CHEST guideline examines the literature on primary treatment of patients with stage I and II non-small cell lung cancer (NSCLC) to provide evidence-based recommendations.
METHODS
An expert panel conducted a systematic review addressing the treatment options for patients with stage I/II NSCLC and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of evidence and grading of recommendations. A modified Delphi approach was used to reach consensus on recommendations.
RESULTS
Based on 578 studies, the panel developed 17 recommendations.
CONCLUSIONS
The best treatment for average or low operative risk patients with stage I NSCLC remains surgical resection. In patients with stage I NSCLC, a minimally invasive approach is preferred over thoracotomy. For the first time, a meta-analysis comparing overall survival for patients with stage I lung cancer reveals an association between minimally invasive surgery and better patient outcomes. New evidence reveals equivalent overall survival for patients with peripheral ≤ 2 cm non-small cell lung cancer treated with a sublobar resection compared to lobectomy. To have confidence in the generalizability of these trials it is important to perform systematic intraoperative mediastinal and hilar lymph node sampling or dissection during operations for…
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