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Guideline registry — lung adenocarcinoma¶
Last curated: 2026-10-30. Earlier documents retain their verification dates; the source recheck below distinguishes version metadata from recommendation review.
Purpose. This registry records exact documents, versions, jurisdictions, and access states. It is not a timeless recommendation list. Lung adenocarcinoma is governed inside NSCLC, lung-cancer screening, pathology, molecular-testing, radiation, CNS, toxicity, and supportive-care guidance. The synthesis lives in guidelines.md.
Master registry¶
| Body | Year/version | Region | Scope | Citation or official source | Status |
|---|---|---|---|---|---|
| ASCO | dynamic source advertises 2026.3.3, updated 2026-07-24; archived article 2026.3.1 | US/international | Stage IV NSCLC without driver alterations | Official living source; archived PMID 42190141 | Official search-indexed version metadata checked 2026-10-23; full dynamic page returned HTTP 403. Archived PMID is not a citation for dynamic v3.3 recommendations |
| ASCO | living 2026.3.4, indexed 2026-10-29 | US/international | Stage IV NSCLC with driver alterations | Official living source; Reuss et al., PMID 42956324 | Current indexed version found 2026-10-30; abstract is boilerplate living-guideline text; dynamic page HTTP 403, so recommendation changes are unverified. Supersedes 2026.3.3 (PMID 42607282) in the version chain |
| UK expert panel | 2026 consensus | United Kingdom | Advanced NSCLC with comorbidities and frailty (23 draft statements; 22 reached ≥70% agreement) | Gomes et al., PMID 42956446 | Added 2026-10-30; UK-specific expert consensus, not a society living guideline. Statement text not reviewed; not used to change treatment recommendations |
| ASCO | 2022 | US/international | Stage III NSCLC | Daly et al., PMID 34936470 | Current published full guideline; update priority noted |
| NICE | NG122, updated 2024-03-08; reviewed 2026-02-10 | England | Diagnosis, staging, treatment, follow-up, palliation | Official NG122 | Current; live fetch HTTP 200 on 2026-08-29 |
| NICE | NG12, updated 2026 | England | Suspected-cancer recognition and referral | Official lung section | Current; live fetch HTTP 200 |
| ESMO | living v1.3, August 2026 | Europe | Early and locally advanced NSCLC | Official living guideline; issuer update listing | Version metadata verified from issuer search listing 2026-10-23; direct retrieval served only the site shell, so recommendations were not reviewed |
| NCCN | professional guideline, current version gated | United States | Complete NSCLC pathway | NCCN authenticated professional source | Current only after account/version verification |
| CAP/IASLC/AMP | 2018 update | International | Molecular testing for targeted TKIs | Lindeman et al., PMID 29398453; IASLC resource | Methods foundation; target list partly superseded by later evidence |
| ASCO | 2018 endorsement | US/international | Endorsement of CAP/IASLC/AMP molecular testing | PMID 29401004; summary PMID 29589987 | Current as endorsement of 2018 methods; not current drug list |
| CAP/AMP/IASLC/PPS/LUNGevity | 2024 | International | PD-L1 and TMB for immuno-oncology | PMID 38625026 | Current; TMB not recommended alone |
| CAP | protocol v5.1.0.0, 2025-09 | International | Lung resection pathology reporting | Cancer protocols | Current; live fetch HTTP 200 |
| CAP | biomarker protocol v2.2.0.0, 2025-09 | International | Structured lung biomarker reporting | Same CAP protocol source | Current; verify exact downloaded version |
| USPSTF | 2021 | United States | LDCT lung-cancer screening | PMID 33687470; official recommendation | Current at review; live fetch HTTP 200 |
| American Cancer Society | 2023 update, published 2024 | United States | LDCT screening | Wolf et al., PMID 37909877 | Current; no quit-year exclusion |
| CHEST | 2021 | International/US | Lung-cancer screening program | Mazzone et al. guideline and expert panel report | Current published program guidance |
| ERS/ESTS | 2009 | Europe | Physiologic fitness for radical treatment | Brunelli et al., PMID 19477657 | Current historical framework; modernization needed |
| ASTRO | 2017 | US/international | SBRT in early-stage NSCLC | Videtic et al., PMID 28596092 | Current foundational; predates recent surgery/perioperative trials |
| ASTRO/ESTRO | 2023 | US/Europe | Oligometastatic NSCLC local therapy | Iyengar et al., PMID 37294262 | Current |
| ASCO/SNO/ASTRO | 2022 | International | Brain metastases | Vogelbaum et al., PMID 34932393 | Current |
| ASCO | 2021 update | International | Immune-related adverse events | Schneider et al., PMID 34724392 | Current published update; recheck before use |
| ASCO/IDSA | 2018 | International | Outpatient febrile neutropenia | Taplitz et al., PMID 29461916 | Current published guidance |
| ASCO | 2023 update | International | Cancer-associated VTE | Key et al., PMID 37075273 | Current published update |
| ATS/STS/STR | 2018 | International | Malignant pleural effusion | Feller-Kopman et al., PMID 30272503 | Current published guidance |
| CHEST | 2025 | International/US | Central-airway obstruction | Mahmood et al., PMID 39029785 | Current |
| Endocrine Society | 2023 | International | Hypercalcemia of malignancy | El-Hajj Fuleihan et al., PMID 36545746 | Current |
| AATS | 2026 revision of 2023 expert consensus | US/international | Staging and multidisciplinary management of early-stage NSCLC: neoadjuvant/perioperative chemo-immunotherapy, adjuvant targeted therapy, adjuvant immunotherapy | Kidane et al., PMID 42790620 | Added 2026-10-16; current revision |
| STS | 2026 expert consensus | US | Definition and practice of sublobar resection (21 Delphi statements) | Khullar et al., PMID 42320552 | Added 2026-10-16; current |
| ESTRO | 2026 | Europe/North America panel | High-dose thoracic reirradiation for NSCLC (42 consensus statements) | Andratschke et al., PMID 42468604 | Added 2026-10-16; current |
| ACR Appropriateness Criteria | 2026 | US | Imaging surveillance of indolent lung cancer (persistent subsolid nodules, atypical cysts) when intervention is deferred | Expert Panel on Thoracic Imaging, PMID 42573542 | Added 2026-10-16; reviewed annually |
| Oncology Society of Chinese Medical Association | 2026 edition | China | Whole-pathway lung-cancer guideline anchored to NMPA-approved indications; updates screening QC, molecular testing, perioperative and EGFR/ALK/KRAS G12C/HER2/MET recommendations | PMID 42764215 (Zhonghua Zhong Liu Za Zhi); parallel publication PMID 42763208 (Zhonghua Yi Xue Za Zhi) | Added 2026-10-16; supersedes 2025 edition; Chinese-language full text not reviewed |
| China National Pathology Quality Control Center | 2026 update | China | Clinical practice of molecular testing in NSCLC | PMID 42851192 | Added 2026-10-16; no English abstract in PubMed; content not verified |
| Korean multidisciplinary panel (Ann Lab Med) | 2026 | Korea | Pleural-effusion and BAL-fluid ctDNA testing in lung cancer (15 Delphi recommendations) | Lee et al., PMID 42844226 | Added 2026-10-16; evidence base dominated by pleural-effusion studies |
| Vietnamese expert panel | 2026 | Vietnam | Resectable NSCLC diagnosis and perioperative management (35 statements) | Do et al., PMID 42870861 | Added 2026-10-16; national consensus (indexed as Review) |
| Austrian ÖRG/ÖGP/ÖGAM/thoracic surgery societies | 2026 | Austria | Position paper on implementing national risk-adapted LDCT screening | Wass et al., PMID 42758313 | Added 2026-10-16; German-language position paper |
Source recheck, 2026-10-23¶
- NICE NG122: the official page was retrieved directly (HTTP 200). It still states last updated 2024-03-08 and last reviewed 2026-02-10; no newer update was displayed. This is a page-level version check, not a review of every linked technology appraisal.
- ASCO: the without-driver dynamic version and its archived article must be tracked separately, as above. Both ASCO dynamic pages returned HTTP 403 to direct retrieval. The with-driver archived v2026.3.3 record was re-fetched in PubMed; a newer dynamic version could not be confirmed.
- Pan-Asian early/locally advanced NSCLC adaptation — verification pending: ESMO's official update listing advertises it on 2026-09-29. A corresponding PubMed record was retrieved, but it currently carries 2027-12-31 publication metadata despite October 2026 indexing. Its PubMed publication types contain no retraction/concern flag; its DOI returned Crossref HTTP 404, and publisher full text returned HTTP 403. Publication date, Crossref retraction status and recommendation content remain [unverified]. It is not added as an evidence source or used to alter treatment recommendations; resolve these discrepancies next sweep.
- NCCN: authenticated professional content was not retrieved; no version or recommendation change is asserted.
Source recheck, 2026-10-30¶
- NICE NG122: official page HTTP 200; title still "Lung cancer: diagnosis and management". No newer update date was extracted from the page shell beyond the existing 2024-03-08 / 2026-02-10 labels recorded on 2026-10-23.
- ASCO: both living pages returned HTTP 403. A new PubMed record for driver-alteration v2026.3.4 (PMID 42956324) was indexed 2026-10-29. Without-driver remains archived 2026.3.1 (PMID 42190141) versus dynamic 2026.3.3 advertising; no newer without-driver PMID was found in this window.
- Pan-Asian early/locally advanced NSCLC adaptation: still pending. A 2026-10-30 PubMed search for
Pan-Asian AND lungin the date window returned PMID 42663933 (NMOSD, not lung) and an ESMO Pan-Asian RCC guideline (PMID 42914499). The previously held lung-cancer Pan-Asian record was not re-resolved with a clean Crossref DOI in this session. - ESMO early/local living page: HTTP 200 with title "ESMO Living Guideline: Early and Locally Advanced NSCLC"; recommendation text was not extracted from the JS-rendered shell.
- USPSTF screening: HTTP 200; still the 2021 recommendation page.
- UK frailty consensus (PMID 42956446): added as an expert-consensus row; 22 of 23 statements reached agreement. Full statement list not reviewed.
Version and access rules¶
- Record issuer, title, version, update date, jurisdiction, and access date.
- For a living guideline, cite the live version for the recommendation and the PMID only for the archived article.
- Do not infer a current NCCN version from a secondary summary; verify inside an authenticated account.
- Record the TNM edition used by the recommendation.
- Separate evidence from regulator authorization and reimbursement.
- Treat automated HTTP denial as an access limitation, not evidence that the document does not exist.
Molecular-testing entries¶
CAP/IASLC/AMP 2018¶
- Citation: Lindeman NI, et al. Updated molecular testing guideline. PMID 29398453.
- Contribution: validated methods, tissue stewardship, EGFR/ALK/ROS1 testing, multiplex principles, plasma caveats, turnaround.
- Current limitation: published before several RET, METex14, NTRK, KRAS G12C, and HER2 approvals.
- Use rule: retain the methods standards; update the target list from current living treatment guidance.
- Supersession chain: 2013 molecular testing guideline → 2018 update → future CAP/IASLC/AMP update [watch].
CAP/AMP/IASLC/PPS/LUNGevity 2024¶
- Citation: PD-L1 and TMB testing guideline, PMID 38625026.
- Contribution: validated PD-L1 assay/reporting; TMB should not be used alone to select immune checkpoint therapy in advanced NSCLC.
- Disagreement addressed: retrospective high-TMB associations do not equal recommendation-grade treatment selection.
Reporting protocols¶
| Protocol | Required fields for this knowledge base |
|---|---|
| Resection | Procedure, site, size/invasive size, patterns, grade, STAS, lymphovascular/pleural invasion, margins, nodes, TNM edition |
| Biomarker | Specimen/date, tumor fraction, assay/platform, exact variant/fusion, copy-number definition, PD-L1 clone/TPS, limitations |
Screening entries¶
| Body | Eligibility | Stop rule | Main divergence |
|---|---|---|---|
| USPSTF 2021 | Annual LDCT age 50–80, ≥20 pack-years, current or quit ≤15 years | >15 quit-years or health limits curative treatment | Quit-year cutoff (PMID 33687470) |
| ACS 2023 | Annual LDCT age 50–80, ≥20 pack-years, current or former | Health/longevity and treatment candidacy | No quit-year cutoff (PMID 37909877) |
| NICE | National-program/referral context | Jurisdiction-specific | Symptomatic people enter diagnosis, not screening |
Neither USPSTF nor ACS supplies a mortality-validated population strategy for never-smokers. TALENT is a prospective detection cohort, not a guideline-grade mortality trial (PMID 38042167).
Early and locally advanced disease entries¶
Surgery and radiation¶
- ERS/ESTS physiology guidance uses spirometry, DLCO, predicted postoperative function, exercise, and cardiac assessment (PMID 19477657).
- ASTRO SBRT guidance supports medically inoperable early-stage NSCLC; central/ultracentral location changes technique and risk (PMID 28596092).
- JCOG0802 and CALGB 140503 postdate several older guidelines and restrict lesser resection to carefully staged small peripheral disease (PMIDs: 35461558, 36780674).
Perioperative systemic therapy¶
| Evidence family | Guideline implication | Unresolved mismatch |
|---|---|---|
| LACE adjuvant cisplatin | Stage II–III survival backbone | Modern targeted/IO addition and sequence (PMID 18506026) |
| ADAURA | Adjuvant osimertinib for eligible EGFR exon-19 deletion/L858R | Duration, MRD, relapse after adjuvant therapy (PMIDs: 32955177, 37272535) |
| ALINA | Adjuvant alectinib for eligible ALK-positive resected disease | Chemotherapy additivity and mature OS (PMID 38598794) |
| CheckMate 816 | Neoadjuvant chemo-nivolumab without required adjuvant IO | Who needs postoperative therapy (PMID 35403841) |
| KEYNOTE-671/AEGEAN/77T | Perioperative chemo-IO | Marginal value of adjuvant component (PMIDs: 37272513, 37870974, 38749033) |
| IMpower010/KEYNOTE-091 | Adjuvant-only checkpoint after resection/chemotherapy | PD-L1 and eligibility differ (PMIDs: 34555333, 36108662) |
Stage III¶
- ASCO 2022 supports concurrent chemoradiation for fit unresectable stage III and consolidation durvalumab when eligible (PMID 34936470).
- PACIFIC provides the efficacy anchor; five-year OS 42.9% versus 33.4% (PMIDs: 28885881, 35108059).
- Gap: genotype-specific consolidation, especially EGFR-mutant disease, requires living-guideline recheck.
Metastatic disease entries¶
Driver-positive¶
The ASCO driver-alteration living guideline was re-searched on 2026-08-29. Version 2026.3.3 (Wheatley Price et al., PMID 42607282) is the current indexed anchor; version 2026.3.1 is PMID 42190143. The previously listed PMID 38476742 is a European implementation review, not an ASCO guideline, and has been removed from this role. At point of use, verify current version, regulator label, prior-treatment requirements, CNS status, and exact variant.
| Driver | Evidence that can change guideline sequence |
|---|---|
| EGFR classical | FLAURA; intensification programs; exact current label (PMIDs: 29151359, 38942080) |
| EGFR exon 20 | PAPILLON (PMID 37870976) |
| ALK | ALEX/CROWN (PMIDs: 28586279, 33207094) |
| ROS1 | Entrectinib/repotrectinib (PMIDs: 31838015, 38197815) |
| RET | LIBRETTO-431 direct first-line comparison (PMID 37870973) |
| METex14 | GEOMETRY/VISION (PMIDs: 32877583, 32469185) |
| BRAF V600E | BRAF–MEK doublets (PMIDs: 28919011, 37270692) |
| HER2 mutation | DESTINY-Lung02 and emerging HER2 TKIs (PMIDs: 37694347, 40293180) |
| KRAS G12C | Randomized later-line evidence; first-line trials active (PMID 36764316) |
Driver-negative¶
- Pembrolizumab plus platinum-pemetrexed is supported across PD-L1 strata by KEYNOTE-189 (PMID 29658856).
- Pembrolizumab monotherapy is supported for selected PD-L1 TPS ≥50%, EGFR/ALK-negative disease by KEYNOTE-024 (PMID 27718847).
- Pemetrexed's nonsquamous advantage is supported by treatment-by-histology interaction (PMID 21119545).
CNS and oligometastatic guidance¶
ASCO/SNO/ASTRO states that symptomatic brain metastases generally receive local therapy regardless of systemic treatment (PMID 34932393). Deferral for a CNS-active targeted agent is a selected, driver-specific decision.
ASTRO/ESTRO conditionally supports definitive local therapy for selected oligometastatic NSCLC when all sites can be treated safely (PMID 37294262). This does not apply to widespread progression or establish a universal lesion count.
Safety and supportive-care entries¶
| Problem | Guideline | Operational point |
|---|---|---|
| Immune toxicity | ASCO 2021, PMID 34724392 | Organ-specific hold, steroids, escalation, discontinuation, rechallenge |
| Febrile neutropenia | ASCO/IDSA 2018, PMID 29461916 | Outpatient only after formal low-risk assessment and reliable follow-up |
| VTE | ASCO 2023, PMID 37075273 | Balance brain disease, hemoptysis, thrombocytopenia, renal function, procedures |
| Pleural effusion | ATS/STS/STR 2018, PMID 30272503 | Symptoms, lung expansion, IPC versus pleurodesis, preference |
| Airway obstruction | CHEST 2025, PMID 39029785 | Multidisciplinary bronchoscopy plus oncologic therapy |
| Hypercalcemia | Endocrine Society 2023, PMID 36545746 | Hydration, antiresorptive therapy, selected calcitonin |
Disagreements and gaps¶
| Topic | Disagreement/gap | Safe handling |
|---|---|---|
| Screening quit-years | USPSTF and ACS differ | Apply governing national program; record rule |
| Never-smoker screening | Cohort detection but no randomized mortality evidence | Do not promote to population recommendation |
| TNM edition | Older guideline groups versus TNM-9 | Preserve actual descriptors and remap |
| Perioperative IO | Neoadjuvant-only and perioperative regimens coexist | Do not cross-trial rank HRs or invent combined therapy |
| Adjuvant targeted therapy | Large DFS/OS effects; duration and MRD unresolved | Follow eligible population, document unknowns |
| Driver testing scope | 2018 document predates targets | Methods retained; target list updated separately |
| TMB | Research associations versus guideline rejection as lone selector | Keep contextual |
| Resource setting | Broad profiling and drugs not universally accessible | Record resource assumptions; do not dilute evidence definition |
| Frailty/ECOG 2–3 | Pivotal trials underrepresent | Individualize; prioritize prospective inclusion |
Superseded-document chains¶
- CAP/IASLC/AMP 2013 molecular guideline → superseded by 2018 update (PMID 29398453) → future update on watch list.
- USPSTF 2013 screening statement → superseded by 2021 recommendation (PMID 33687470).
- IASLC/ATS/ERS 2011 adenocarcinoma classification (PMID 21252716) → incorporated and revised through WHO 2015 → WHO 2021 (PMID 34808341).
- TNM seventh edition → eighth edition → ninth edition staging era from 2025 (PMIDs: 38447919, 38885896).
- ASCO stage-IV static publications → living-guideline versioning; archived PMID never proves the current web version.
- ASCO driver-alteration living guideline 2026.3.1 (PMID 42190143) → 2026.3.2 (Puri et al., PMID 42372216, J Clin Oncol issue dated 2026-09-10) → 2026.3.3 (PMID 42607282) → 2026.3.4 (Reuss et al., PMID 42956324, indexed 2026-10-29). Version 3.2 was indexed after 3.3, so issue dates do not give version order; use the version number. Recommendation content of 3.4 is [unverified] from the abstract and the blocked dynamic page.
- Oncology Society of CMA lung-cancer guideline 2025 edition → 2026 edition (PMIDs: 42764215, 42763208).
Watch list¶
- ASCO stage-IV living-version changes and transparent changelog.
- CAP/IASLC/AMP comprehensive molecular-testing update.
- ESMO and NCCN incorporation of new first-line EGFR/KRAS/HER2 data.
- Genotype-specific unresectable stage-III consolidation.
- Mature OS from perioperative immune and ALINA programs.
- Randomized MRD-guided escalation/de-escalation.
- Never-smoker screening trials with mortality and overdiagnosis endpoints.
- TNM tenth-edition development.
Registry quality checklist¶
- [x] Official source preferred where accessible.
- [x] Every PMID resolved through live PubMed E-utilities on 2026-08-29.
- [x] Jurisdiction and version recorded.
- [x] Living web source separated from archived PMID.
- [x] Superseded chains retained.
- [x] Genuine disagreements preserved.
- [x] Access failures labeled rather than hidden.
- [ ] NCCN professional version must be verified in an authenticated account at point of use.