Source: DGNews  |  Posted 1 year ago

By Ed Susman

HOLLYWOOD, Fla -- March 14, 2010 -- A new staging system for non-small-cell lung cancer further stratifies cancer by size of the nodules, doctors reported here at the 15th Annual National Comprehensive Cancer Network (NCCN) Conference on Clinical Practice Guidelines and Quality Cancer Care.

“What has changed here is the T classification,” said David Ettinger, MD, Johns Hopkins University, Baltimore, Maryland. Johns Hopkins is one of the 21 member institutions of the NCCN, whose guidelines are now considered the standard of care worldwide.

The NCCN lung cancer guidelines committee incorporated the seventh edition of the International Association for the Study of Lung Cancer project.(1)

Previously the T staging was split between T2 and T3 if the tumour measured 3 cm in diameter. “Now we go up to 7 cm,” Dr. Ettinger said in presenting the guidelines on March 13.

He noted that tumour staging is important in prognosis and is also important in clinical research where inclusion and exclusion criteria can impact patient selection for clinical trials.

Among the changes that affect staging between T2 and T3 tumours are:
· A former stage T2N1 tumour that is 3 to 5 cm in diameter is now classified as T2a.
· A former stage T2N0 tumour that is 5 to 7 cm in diameter is now classified as T2b.
· A former stage T2N1 tumour that is >7 cm in diameter is now classified as T2b.
· A former stage T3NI tumour that is >7 cm in diameter is now classified as T3.

“Another change is that pleural effusion used to be called T3b disease, now we call it stage 4,” Dr. Ettinger said.

“What hasn’t changed in the new classification system is the nodal system,” he said.

“In a sense the new classification system is not going to change what the recommendations are for treatment of patients,” Dr. Ettinger said.

1. Goldstraw P et al. J Thorac Oncol. 2007;2:706-714.

[Presentation title: NCCN Non-Small Cell Lung Cancer Guidelines Update]