Standards, Options and Recommendations for the management of locally advanced non small cell lung carcinoma

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists om French Pub lic Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of e xperts, with feedback from specialists in cancer rare delivery. Objectives: To develop clinical practice guidelines according to the definitions of th e Standards, Options and Recommendations project for the management of loca lly advanced non small cell lung carcinoma. methods: Data were identified b y searching Medline and the personal reference lists of members of the expe rt groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 Fr ench Cancer Centres. Results: The main recommendations are: 1) The manageme nt of the locally advanced non small cell lung carcinoma has two main goals : firstly to obtain local control of the disease (or to at least delay loca l progression in order to improve the survival or relapse fi ee survival), and secondly to prevent the development of metastases. 2) There is a consen sus that locally advanced non small cell lung carcinoma should be irradiate d. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poo r life expectancy, this can be delivered as a split-course or hypofractiona ted scheme. 3) Treatment for patients with a performance status of 0-1 shou ld consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional r adiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combine d radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside cli nical trials. Surgery is justified in stage N2 disease as good local contro l can be achieved. T4-NO disease should be treated surgically with curative intent.