- Describe your topic.
- Our topic is the Treatment of Stage III Non-small Cell Lung Cancer. The following are suggesting the following PICO questions pertaining to this topic: In patients with unresectable pathologic stage IIIa or IIIb NSCLC, and good performance status (ECOG 0-1), what is the effect of concurrent chemo-radiation therapy compared to sequential chemo-radiation on overall survival. In patients with unresectable pathologic stage IIIa or IIIb NSCLC, and good performance status (ECOG 0-1), what is the effect of concurrent chemo-radiation therapy compared to sequential chemo-radiation on overall survival In patients with a complete response after treatment for Stage IIIa or IIIb NSCLC treated with definitive chemo-radiation, what is the effectiveness of prophylactic cranial radiotherapy on incidence of cranial metastasis and survival? In patients with pathologic stage IIIa or IIIb NSCLC and marginal performance status (ECOG 2), how effective is concurrent chemo-radiation therapy compared to sequential chemo-radiation therapy on overall survival? In patients with pathologic stage IIIa or IIIb NSCLC, and marginal performance-status (ECOG 2), what is the treatment related toxicity of concurrent chemo-radiation therapy compared to sequential chemo-radiation therapy? In patients with stage III lung cancer diagnosed intraoperatively and completely resectable gross disease, does complete surgical resection followed by adjuvant chemotherapy compared to definitive chemo-radiation therapy without resection improve overall survival? In patients with stage IIIa lung cancer diagnosed pre-operatively, does neoadjuvant chemo-radiation therapy followed by surgical resection compared to definitive chemo-radiation without resection improve overall survival? In patients with stage III lung cancer diagnosed pre-operatively, and treated with neoadjuvant chemoradiatoin therapy, does repeat pathologic staging of the mediastinum, followed by surgery only if the mediastinal nodes are pathologically negative, compared to surgery reagardless of the status of mediastinal lymph nodes improve overall survival? In Patients with potentially resectable stage III lung cancer diagnosed pre-operatively, and treated with neoadjuvant chemoradiation therapy who undergo re-staging of the mediastinum, is staging with EBUS compared to PET scan more accurate? In Patients with potentially resectable stage III lung cancer diagnosed pre-operatively, and treated with neoadjuvant chemoradiatoin therapy who undergo re-staging of the mediastinum, does staging with EBUS compared to staging with PET scan improve overall survival? In Patients with stage III lung cancer diagnosed intraoperatively, does additiona of adjuvant radiotherapy after complete resection compared to adjuvant chemotherapy alone improve overall survival and local control? In Patients with pathologically confirmed stage IIIa NSCLC and good performance status (ECOG 0-1) treated with neoadjuvant chemo-radiation therapy followed by surgical resection, does requiring pneumonectomy for compelte resection compared to requiring only lobectomy reduce peri-operative mortality?
- Describe why this topic is important.
- Stage III non-small cell lung cancer (NSCLC) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky nodal disease. The landscape for the optimal management for this group of patients has continued to evolve, therefore a new evidence review is warranted to assist physicians in determining ideal treatment options for this set of patients.
- Tell us why you are suggesting this topic.
- Treatment of Stage III NSCLC has been the focus of 3 editions of the evidence-based Lung Cancer guidelines developed by the American College of Chest Physicians (CHEST), the last of which was published in 2013 and accepted by the National Guideline Clearinghouse. CHEST aims to update its guidelines every 5 years per the National Academy of Medicine (formerly IOM) and AHRQ standards, but due to increased demand for guidelines, has fallen short on this objective. Development of an evidence review on at least some, if not all, of the PICO's described above would serve as the source document to facilitate the update of these important guidelines.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- As described above, evidence reports form the basis of all CHEST clinical practice guidelines. If this topic is selected for an AHRQ evidence report, the results of that report will directly inform an update of the guideline on Treatment: Stage III NSCLC. The original selection of this topic was due to professional demand based on inconsistent or lack of clear guidance based on current evidence. CHEST guidelines have been touted as a useful tool to assist in clinical decision-making, resulting in improved concordance between practice and the larger body of published evidence. In order to meet the National Academy of Medicine (formerly IOM) standards, it is imperative that an updated evidence report be developed to update the guidelines.
- How will you or your group use the information from a new evidence report?
- As described above, the evidence report will be directly used to inform the update of evidence-based guidelines on this topic.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The report will be disseminated in the following ways: 1) communications to CHEST membership (nearly 19,000 healthcare providers) via electronic (ie eNews Alerts), print (ie CHEST Physician Newsletter), and social media. There will also be opportunities to inform providers about the report through our eLearning and Live Learning platforms, including our Annual Conference. Finally, the report will be referenced as the source document for the subsequent update of the guideline, furthering dissemination of the report as well as use of its contents in clinical practice.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- CHEST serves as the primary organization that will directly use this evidence report to update our clinical practice guideline on the treatment of Stage III NSCLC. Such guidelines have the opportunity to change clinical practice by improving clinical decisions in concordance with current evidence. Other organizations that would also benefit from this evidence report include: the American Society of Clinical Oncology, American Association for Bronchology and Interventional Pulmonolgy, Society of Thoracic Surgeons, and the Oncology Nursing Society
- Information About You: (optional)
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- Provide a description of your role or perspective.
- The American College of Chest Physicians (CHEST) is a professional society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American College of Chest Physicians (CHEST)
- Please tell us how you heard about the Effective Health Care Program.
- CHEST has collaborated with AHRQ in the past on evidence reviews
