HOLLYWOOD, FloridaChanges in the 2006 National Comprehensive Cancer Network (NCCN) guidelines for non-small-cell lung cancer (NSCLC) reflect fast-moving changes in imaging, in the availability of treatment agents, and in data supporting concurrent chemoradiotherapy (CRT) over sequential chemotherapy plus radiation. David S. Ettinger, MD, of Johns Hopkins Kimmel Comprehensive Cancer Center, and Mark G. Kris, MD, of Memorial Sloan-Kettering Cancer Center, discussed the guidelines changes at the NCCN 11th Annual Conference.
Dr. Ettinger outlined the main changes to the guidelines, which include:
Deletion of chest x-ray and deletion of lactate dehydrogenase (LDH) as part of the chemistry profile in initial evaluation of patients with NSCLC.
Separation of clinical stage I NSCLC into peripheral T1 and peripheral T2, with the latter added to stage I central and stage II disease.
Use of brain MRI for nonsquamous stage II NSCLC.
Adding adjuvant treatment for stage IA NSCLC in high-risk patients such as those with poorly differentiated tumor, vascular invasion, wedge resection, or minimal margins (category 2B recommendation).
Adding pulmonary function tests (PFTs) to pretreatment evaluations if PFTs were not done previously.