Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer

1 Methodological Introduction

This abridged version is based on an interdisciplinary guideline which corresponds to development stage 3 (S3) of guidelines according to the classification of the Association of the Scientific Medical Societies in Germany (AWMF). The guideline development process is characterized by the combination of formal evidence-search, formal consensus, logic (algorithms), decision and outcome analysis, and interdisciplinary development with the cooperation of 15 German and Austrian medical societies. [Table 1] shows the relationship between levels of evidence, consensus, and resulting recommendation grades of the recommendations of this guideline. The recommendation grades A – D are added to the recommendations in the abridged version. For the evidence levels, see the full version [1].

Table 1  Relationship between levels of evidence and grades of recommendation (modified according to Oxford Center for Evidence-based Medicine 2001 2 and AWMF 3). Evidence Level Evidence Consensus Grade of recommendation Therapy Diagnosis Modifying criteria for recommendation 1a Systematic Review (SR) of Randomized Controlled Clinical Trials (RCTs) SR of Level 1 diagnostic studies – Ethical aspects– Patient preferences– Clinical relevance, integrated outcome– Clinically significant deviation from study situation– Studies: consistency, effectiveness– Benefits, risks, side effects– Applicability A Strong recommendation 1b Individual RCT (with narrow confidence interval) Validating cohort study with good reference standards 1c All or none Absolute specifity for ruling in or absolute sensitivity for ruling out the diagnosis 2a SR of cohort studies SR of Level > 2 diagnostic studies B Moderate recommendation 2b Individual cohort study, low quality RCT Exploratory cohort study with good reference standards 2c ”Outcomes” Research 3a SR of case-control studies SR of non-consecutive studies 3b Individual case-control study Non-consecutive study 4 Case-series, poor quality cohort and case-control studies Case-control study, poor or non-independent reference standard C Weak recommendation 5 Expert opinion without critical appraisal, or based on physiology etc. Expert opinion without critical appraisal, or based on physiology etc. D Missing or inconsistent studies, recommendation based on expert opinion

For the preparation of this guideline the 6th edition of the TNM classification and staging system of UICC (International Union Against Cancer) was used which was valid until Dec 31, 2009. The changes in the classification and staging system carried out in the 7th edition, valid from Jan 01, 2010, are presented in chapter 5 (Diagnosis) of the full version of the guideline. The changes in the 7th edition of the UICC classification [4] result in an amendment in chapter 6 (Treatment of non-small cell lung carcinoma) and in the algorithm for the treatment of non-small cell lung cancer in stage IIIB ([Fig. 7]), where subgroup T4N0/1M0 no longer belongs to stage IIIB – as in the 6th edition –, but to stage IIIA. The recommendations for the therapeutic approach in subgroup T4N0/1M0 are not affected by the change in classification.

In this abridged version the recommendations of the guideline are summarized. The full version of the guideline has been published in printed form (Pneumologie 2010; 64, Supplement 2: S23 – S155) and electronic form (http://dx.doi.org/10.1055/s-0029-1243837). The electronic version includes the bibliography and appendices (occupational history form, evidence tables, addendum and guideline report).

0 Abridged Version.

References

• 1 Goeckenjan G, Sitter H, Thomas M et al. Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Interdisziplinäre S3-Leitlinie.  Pneumologie. 2010;  64, Supplement 2 S23-S155 http://dx.doi.org/10.1055/s-0029-1243837
• 2 Oxford Centre for Evidence-based Medicine (CEBM) .Levels of evidence. Oxford; 2001. www.cebm.net access: 6-2-2006
• 3 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften .Leitlinien-Informationssystem der AWMF. http://leitlinien.net access: 6-2-2006
• 4 Sobin L H, Gospodarowicz M K, Wittekind C. UICC. TNM Classification of Malignant Tumours. 7th ed. Wiley-Blackwell; 2009
• 5 Robinson L A, Wagner Jr. H, Ruckdeschel J C. Treatment of stage IIIA non-small cell lung cancer.  Chest. 2003;  123 202S-220S
• 6 Robinson L A, Ruckdeschel J C, Wagner Jr. H et al. Treatment of nonsmall cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132 243S-265S
• 7 Albain K S, Swann R S, Rusch V W et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial.  Lancet. 2009;  374 379-386
• 8 Kris M G, Hesketh P J, Somerfield M R et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006.  J Clin Oncol. 2006;  24 2932-2947
• 9 The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC) . Prevention of chemotherapy and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference.  Ann Oncol. 2006;  17 20-28
• 10 Bundesarbeitsgemeinschaft für Rehabilitation (BAR) .Rahmenempfehlungen zur ambulanten onkologischen Rehabilitation. Frankfurt am Main: Bundesarbeitsgemeinschaft für Rehabilitation; 2004

0 Abridged Version.

1 In the current 7th edition of the UICC classification T4N0-1M0 is assigned to stage IIIA and no longer – as in the sixth edition – to stage IIIB.

2 Definition: A pleural effusion is called malignant if malignant cells or tissues are detected in it.