NICE updates lung cancer guidelines

  • Maconachie R & al.
  • BMJ
  • 28 Mar 2019

  • Oncology guidelines update
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Takeaway

  • The National Institute for Health and Care Excellence (NICE) has issued updated guidelines on the diagnosis and treatment of lung cancer.

Why this matters

  • The updated guidelines include research on staging, radiotherapy, and systemic treatments published since the guidelines were last updated in 2011.

Key updates and recommendations

  • A new NSCLC staging algorithm describes when to use certain diagnostic and staging procedures, and in what order.
  • Nonultrasound-guided transbronchial needle aspiration is no longer recommended.
  • Pretreatment brain imaging is recommended for patients with stage II and III NSCLC who are candidates for curative treatment.
  • Lobectomy remains the treatment of choice for stage I and II NSCLC.
  • Stereotactic ablative radiotherapy (SABR) is recommended for nonsurgical patients, except for tumors within a 2-cm radius of the main airways and proximal bronchial tree.
  • Recommendations for conventional or hyperfractionated radiotherapy schedules for patients not undergoing surgery or SABR.
  • Chemoradiotherapy and surgery should be offered for operable stage IIIA-N2 NSCLC.
  • A new systemic therapy algorithm recommends medications for advanced NSCLC based on tumor histology and biomarkers.
  • Recommendation for prophylactic cranial irradiation for SCLC was downgraded from "offer" to "consider."
  • Twice-daily chemoradiotherapy for limited-stage SCLC is recommended, if possible.