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Am J Clin Oncol. 2014 Apr;37(2):201-7. doi: 10.1097/COC.0000000000000013.

ACR appropriateness Criteria® early-stage non-small-cell lung cancer.

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*Cleveland Clinic Foundation, Cleveland, OH †MD Anderson Cancer Center, Houston, TX ‡Henry Ford Health System, Detroit, MI §Department of Surgery, Columbia University ∥Society of Thoracic Surgeons, New York, NY ¶21st Century Oncology/Michigan Healthcare Professionals, Farmington Hills, MI #University of Michigan and Ann Arbor Veteran Affairs Medical Center, Ann Arbor, MI **Department of Radiation Oncology, University of Miami, Miami, FL ††Stanford University and Stanford Cancer Institute, Stanford, CA ‡‡University of North Carolina Health Care System §§American Society of Clinical Oncology, Chapel Hill, NC ∥∥Massachusetts General Hospital, Boston, MA ¶¶Mount Sinai School of Medicine, New York, NY.


Early-stage non-small-cell lung cancer (NSCLC) is diagnosed in about 15% to 20% of lung cancer patients at presentation. In order to provide clinicians with guidance in decision making for early-stage NSCLC patients, the American College of Radiology Appropriateness Criteria Lung Cancer Panel was recently charged with a review of the current published literature to generate up-to-date management recommendations for this clinical scenario. For patients with localized, mediastinal lymph node-negative NSCLC, optimal management should be determined by an expert multidisciplinary team. For medically operable patients, surgical resection is the standard of care, with generally no role for adjuvant therapies thereafter. For patients with medical comorbidities making them at high risk for surgery, there is emerging evidence demonstrating the availability of low toxicity curative therapies, such as stereotactic body radiotherapy, for their care. As a general statement, the American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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