Table 4 Summary of UK, European and American guidelines on the management of potentially resectable N2 NSCLC.
From: The current treatment landscape in the UK for stage III NSCLC
Guideline | Definition of ‘resectable’ | Recommendations | Notes |
|---|---|---|---|
BTS and SCTS (2010) | Non-fixed lymph nodes Non-bulky lymph nodes Single-zone N2 disease Reasonable chance of: Complete resection Clear pathological margins | Consider surgery as part of multi-modality treatment in non-fixed, non-bulky, single-zone N2 NSCLC Further research into the role of surgery in non-fixed, non-bulky, multi-zone N2 NSCLC | Significant weight placed on IASLC staging database outcomes despite lack of comparator group and lack of clinical N2 Guidelines consider evidence for adjuvant chemotherapy more robust than pre-operative chemotherapy |
ACCP (2013) | Discrete lymph nodes Easily measurable and defined lymph nodes Free from major structures, such as the great vessels and trachea | Definitive CRT or induction therapy (chemotherapy or CRT) followed by surgery Surgery followed by adjuvant chemotherapy not recommended | Does not support the concept that surgery can only be justified in patients with minimal N2 disease Pre-operative chemotherapy better than surgery alone in all NSCLC (small studies) and therefore surgery plus adjuvant chemotherapy is not recommended |
ESMO (2015) | Minimal, non-bulky N2 disease Single-station N2 disease | Definitive CRT, induction chemotherapy followed by surgery or induction CRT followed by surgery | Paramount importance of an experienced and high-volume multi-disciplinary team (MDT) and treatment centres able to minimise risk and complications from multi-modality treatment highlighted |
NCCN (2018) | Low-volume lymph nodes Non-invasive lymph nodes Pathologically proven Measuring <3 cm | Definitive CRT or induction chemotherapy followed by surgery or induction CRT followed by surgery Maintenance durvalumab following cCRT | Benefit from pre-operative chemotherapy is similar to that of post-operative chemotherapy and either approach is justified |
NICE (2019) | None provided | Consider CRT followed by surgery | CRT followed by surgery improves PFS and might improve survival compared with CRT alone |
