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Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002)

Year: 2003

Type: article

Abstract: The objective was to define guidelines for the management of adult patients with carcinomas of unknown primary site. These guidelines are aimed at health professionals treating these patients with the goal of helping to homogenising clinical practice. The principal questions addressed in this document are: What pathological diagnostic strategies should be used for each localisation? What pathological diagnostic strategies should be used for each localisation? To what extent should the primary site be searched for, and what are the limits for this strategy? To what extent should the primary site be searched for, and what are the limits for this strategy? What are the prognostic factors? What are the prognostic factors? What treatment strategies should be used for each anatomoclinical type? What treatment strategies should be used for each anatomoclinical type? The details of the full methodology have been previously published ( Fervers et al, 2001 ). In summary, a multidisciplinary working group was set up by the French National Federation of Cancer Centres (Fédération Nationale des Centres de Lutte Contre le Cancer–FNCLCC) to review the literature on the management of patients with carcinomas of unknown primary site. Medline was searched between 1980 and 2001 using keywords pertinent for each topic covered and this was completed with references provided by the members of the working group. The majority of the articles were in English and French. After selection and critical appraisal of this literature, the working group defined the ‘Standards’, ‘Options’ and ‘Recommendations’ (SORs) for the management of patients with carcinomas of unknown primary site, based on a synthesis of the best available evidence and expert agreement. These guidelines were then reviewed by a group of independent experts (see the Appendix ) and finalised after taking into consideration their comments. SORs are considered as being validated when the members of the working group give their agreement for publication. When all the members of the working group agree, based on the best available evidence, that a procedure or intervention is beneficial, inappropriate, or harmful, it is classified as a ‘Standard’, and when the majority agree, it is classified as an ‘Option’ ( Table 1 ). In the SORs, there can be several ‘Options’ for a given clinical situation. ‘Recommendations’ provide additional information that enable the available options to be ranked using explicit criteria (e.g. survival, toxicity) with an indication of the level of evidence. These recommendations thus help clinicians to select an appropriate option. Thus, clinicians can make choices for the management of patients using this information and taking into consideration local circumstances, skills, equipment, resources and/or patient preferences. The adaptation of the SOR to the local situation is allowable if the reason for the choice is sufficiently transparent and this is crucial for successful implementation. Inclusion of patients in clinical trials is an appropriate form of patient management in oncology and is recommended frequently within the SORs, particularly in situations where only weak evidence exists to support a procedure or an intervention. The type of evidence underlying any ‘Standard’, ‘Option’ or ‘Recommendation’ is indicated using a classification developed by the FNCLCC based on previously published methods. The level of evidence depends not only on the type and quality of the studies reviewed, but also on the concordance of the results ( Table 2 ). When no clear scientific evidence exists, judgement is made according to professional experience and consensus of the expert group (‘expert agreement’), and this is then validated by the peer-review process. This is a translation of the French version of the summary rapport ( Bugat et al, 2002 ), which was based on the full-text version in French, available on internet at the following address: http://www.fnclcc.fr . The document will be updated as new evidence becomes available or there is a change in expert agreement. The list of abbreviations used in this article and their meaning is given in Table 3 .

Source: British Journal of Cancer

DOI: 10.1038/sj.bjc.6601085