Today, we are comparing American College of Chest Physicians (CHEST), American Association for Thoracic Surgeons (AATS), and American Society of Clinical Oncology (ASCO) guidance on early-stage NSCLC, particularly their recommendations on adjuvant therapy.
The aforementioned guidance was published in 2025, 2023, and 2022, respectively. Some of the recommendations overlap across multiple stages of NSCLC. These recommendations have been included in the categories their recommendations represent, so some recommendations appear multiple times in our comparison table, featured below. Additionally, the CHEST and ASCO publications are clinical guidelines, while the AATS publication is an expert consensus statement.
Clinical Guidance for Comparison
| Document Title | Management of Patients with Early-Stage Non-Small Cell Lung Cancer | Staging and Multidisciplinary Management of Patients with Early-stage Non–small Cell Lung Cancer | Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non–Small-Cell Lung Cancers |
|---|---|---|---|
| Authoring Organization | American College of Chest Physicians (CHEST) | American Association for Thoracic Surgery (AATS) | American Society of Clinical Oncology (ASCO) |
| Publication Date | June 2025 | June 2023 | February 2022 |
| Links | Summary / Full Text | Summary / Full Text | Summary / Full Text |
Key Comparisons Between CHEST, AATS, & ASCO Guidance
Each of the three publications dedicates space to discussing adjuvant therapies, but the focus ranges in scope depending on the overall length of the guideline itself. For example, the CHEST guideline has sections on minimally invasive approaches, extent of resection, surgical settings, lymph node evaluation, stereotactic body radiotherapy and ablative techniques, and adjuvant therapy. The AATS consensus, on the other hand, has a tighter focus on diagnosis and staging, neoadjuvant therapy, and adjuvant therapy.
Today's side-by-side comparison focuses on stage I-III adjuvant systemic therapy and stage I-III adjuvant radiation therapy. The CHEST guideline listed no recommendations for adjuvant radiation therapy, while the AATS and ASCO publications did. Consult the full-text links above for the complete look at each of the published guidance, including recommendations that fall outside the focus of today's comparison.
Comparison of Recommendations Side by Side
| Topic | CHEST | AATS | ASCO |
|---|---|---|---|
| Adjuvant Systemic Therapy Stage I | For patients with completely resected stage I NSCLC, we do NOT recommend routine treatment with adjuvant chemotherapy or immunotherapy outside of a clinical trial. For patients with resected stage IB NSCLC and epidermal growth factor receptor (EGFR) ex19del/L858R mutations, we recommend treatment with adjuvant targeted therapy. | All patients with resected IB-IIIA lung adenocarcinoma AND with EGFR mutations should be referred to medical oncology for discussion of adjuvant osimertinib, whether or not adjuvant cytotoxic chemotherapy is considered possible/desired. | Stage IA: Adjuvant chemotherapy is NOT recommended. Stage IB (3< T ≤ 4 cm, N0M0). Adjuvant osimertinib is recommended for patients with sensitizing epidermal growth factor receptor (EGFR) (Ex19del or L858R) mutations. Adjuvant cisplatin-based chemotherapy and/or atezolizumab are NOT recommended for routine use in this patient group. A postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant therapies for each patient. Factors to consider other than tumor stage when making a recommendation for adjuvant therapy are outlined after the adjuvant systemic therapy section of the 2017 guideline. |
| Adjuvant Systemic Therapy Stage II/III | For patients with completely resected stage II NSCLC, we recommend treatment with adjuvant chemotherapy. For patients with completely resected stage II NSCLC and alterations in EGFR or anaplastic lymphoma kinase, we recommend adjuvant targeted therapy following chemotherapy. For patients with completely resected stage II NSCLC without EGFR or anaplastic lymphoma kinase alterations, we suggest adjuvant immunotherapy following chemotherapy. | All patients with resected IB-IIIA lung adenocarcinoma AND with EGFR mutations should be referred to medical oncology for discussion of adjuvant osimertinib, whether or not adjuvant cytotoxic chemotherapy is considered possible/desired. All patients with resected II-IIIA NSCLC patients with PD-L1 staining ≥1% should be referred to medical oncology for consideration of adjuvant immunotherapy after adjuvant chemotherapy. | Stages IIA, IIB, and IIIA. Adjuvant cisplatin-based chemotherapy is recommended for all patients. Adjuvant osimertinib is recommended after chemotherapy for patients with tumors with sensitizing EGFR mutations, regardless of PD-L1 status. Adjuvant atezolizumab is recommended for all patients with PD-L1 ≥1% after cisplatin-based chemotherapy except for patients with sensitizing EGFR mutations. |
| Adjuvant Radiation Therapy Stage I | N/A | Postoperative radiation therapy to the mediastinum should not be routinely given to resected patients with NSCLC with incidental/unforeseen (i.e., “surprise”) pathologic N2 disease. | Stage IA/B and IIA/B: Adjuvant radiation therapy is NOT recommended. |
| Adjuvant Radiation Therapy Stage II/III | N/A | Postoperative radiation therapy to the mediastinum should not be routinely given to resected patients with NSCLC with incidental/unforeseen (i.e., “surprise”) pathologic N2 disease. | Stage IIIA (N2): Adjuvant radiation therapy is NOT recommended for routine use. A postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks for adjuvant radiotherapy for each patient with N2 disease. |
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