The 5th Peking Union Respiratory Summit and the 1st American College of Chest Physicians (ACCP) Clinical Summit on Recent Advances in Respiratory and Critical Care were held in Beijing on April 24-25, 2010. Unlike previous conferences, this year’s conference was held jointly with ACCP for the first time, and a number of foreign experts, including four ACCP past presidents, were invited to the conference, and they communicated with Chinese experts and more than 1,000 attendees. In January 2003 and September 2007, the American College of Chest Physicians (ACCP), released the 1st and 2nd editions of the Guidelines for the Diagnosis and Management of Non-Small Cell Lung Cancer, respectively. The 3rd edition of the guidelines will be released in 2012 and is currently in preparation. ACCP Past President Michael Alberts, University of South Florida, USA Professor Michael Alberts, former President of ACCP, is the author of the NSCLC guidelines. In his presentation, he describes the rationale for the guidelines. Stage I and II patients: surgery is still the mainstay For patients with stage I and II non-small cell lung cancer (NSCLC), surgery is the most effective treatment. At present, lobectomy + lymph node dissection with at least three stations has been widely used in clinical practice, but still 10% to 55% of patients need total lung resection. Depending on the staging, the 5-year survival rate after surgery is 36% to 73% for patients with stage I and II disease; thus, postoperative recurrence is common, with systemic recurrence accounting for 2/3 and local recurrence accounting for 1/3. Research on the efficacy of postoperative adjuvant chemotherapy has been ongoing. Studies in the 1970s or 1980s suggested that postoperative adjuvant chemotherapy increased patient mortality; studies in the 1990s showed uncertain efficacy, and in 2006, a pooled analysis (the LACE study) that included 4584 patients showed that postoperative adjuvant chemotherapy reduced the risk of death and increased patient survival by 5.4% at 5 years. The results of a large number of studies suggest that postoperative adjuvant chemotherapy is generally not recommended for stage IA and IB patients, and that a platinum-containing chemotherapy regimen is recommended for stage II patients if they are in fair physical condition. For patients with stage I and II NSCLC who cannot be operated for various reasons, other treatments can be considered. The first is radiotherapy, which can obtain a cure rate of 15% to 35%. For stage I patients, radical radiotherapy is the next best option to surgery, but radiotherapy is significantly less useful than surgical treatment. Some new radiotherapy techniques, such as stereotactic radiotherapy, can improve the efficacy. Stage III patients: the most challenging to treat For patients with stage III NSCLC, there are options for surgical, non-surgical treatment, or a combination of both, and for some patients, multidisciplinary collaborative treatment. Although not yet endorsed by the American Joint Committee on Cancer (AJCC), stage IIIA patients are still recommended to be divided into 4 groups IIIA1: surgical specimens with lymph node metastasis, postoperative radiotherapy and/or chemotherapy is recommended; IIIA 2: intraoperative lymph node metastasis found, complete resection if possible, postoperative adjuvant therapy; III A3: intraoperative or preoperative lymph node metastasis found, neoadjuvant therapy can be considered; IIIA4: multisite lymph node metastasis, radiotherapy or chemotherapy is recommended. For patients with stage IIIB NSCLC, if the physical condition is good, combined radiotherapy and chemotherapy are recommended, and the efficacy is better if performed simultaneously, and better tolerated if sequential treatment is given. If the patient is in poor physical condition, radiotherapy alone is recommended. Stage IV patients: non-curative, mainly for symptom relief For patients with stage IV NSCLC who are still in good physical condition, tumor-related treatment can be performed. This treatment is accompanied by certain risks, but it can appropriately improve patient survival, alleviate symptoms and improve quality of life. Studies have shown that the latest standard chemotherapy can extend patient survival by 3 to 4 months (overall survival 8 to 12 months), with a 1-year survival rate of 33% (about 10% for untreated patients). For stage IV non-curative elderly or poor physical status patients, monotherapy or platinum-containing combination therapy is available.