Definitive and Adjuvant Radiation Therapy in Non-small Cell Lung Cancer (NSCLC)
Publication Date: March 1, 2015
Key Recommendations
For curative-intent treatment of locally advanced NSCLC, concurrent chemoradiation is recommended because it improves local control and overall survival compared with sequential chemotherapy followed by radiation or radiation therapy alone.
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The standard dose-fractionation of radiation with concurrent chemotherapy is 60 Gy given in fractions of 2 Gy once per day over 6 weeks. Dose escalation beyond 60 Gy with conventional fractionation has not been demonstrated to be of benefit.
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There is no role for the routine use of induction chemotherapy before chemoradiotherapy.
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There is no role for the routine use of consolidation chemotherapy after chemoradiotherapy. Current data fail to support routine use of consolidation chemotherapy after chemoradiotherapy, but this remains an option for patients who did not receive full systemic chemotherapy doses during radiotherapy.
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The ideal concurrent chemotherapy regimen has not been determined. The two most common regimens are cisplatin/etoposide and carboplatin/paclitaxel.
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For patients who cannot tolerate concurrent chemoradiotherapy, sequential chemotherapy followed by radical (definitive) radiation is recommended because it improves overall survival when compared to radiotherapy alone.
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Radiotherapy alone may be used for patients ineligible for combined modality treatment; it may offer better tolerability, but poorer survival.
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Postoperative radiotherapy may be recommended for patients with complete resection of N2 disease to improve local control, but should be delivered sequentially after adjuvant chemotherapy.
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Postoperative radiotherapy is recommended for patients with incomplete resection (microscopic or gross positive margin, or gross residual disease), to be given either concurrently or sequentially with chemotherapy.
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Patients with resectable stage III NSCLC should be managed by a multidisciplinary team that uses best surgical judgment. The best candidates for preoperative chemoradiotherapy have preoperatively planned lobectomy (as opposed to pneumonectomy), no weight loss, female sex, and only one involved nodal station.
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Title
Definitive and Adjuvant Radiation Therapy in Non-small Cell Lung Cancer (NSCLC)
Authoring Organization
American Society for Radiation Oncology
Publication Month/Year
March 1, 2015
External Publication Status
Published
Country of Publication
US
Document Objectives
The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on external-beam radiotherapy for patients with locally advanced non–small-cell lung cancer (NSCLC). Because of its relevance to the American Society of Clinical Oncology (ASCO) membership, ASCO endorsed the guideline after applying a set of procedures and a policy that are used to critically examine and endorse guidelines developed by other guideline development organizations.
Target Patient Population
Patients with stage II or III LA NSCLC whose disease is unresectable, and patients with stage II or III disease who are eligible for surgery
Target Provider Population
Medical, radiation, and surgical oncology clinicians and other providers
Inclusion Criteria
Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D002289 - Carcinoma, Non-Small-Cell Lung, D018787 - Radiation Oncology, D008495 - Medical Oncology
Keywords
lung cancer, non-small cell lung cancer, Non Small Cell Lung Cancer, non_small_cell_lung_cancer, oncology
Source Citation
DOI: 10.1200/JCO.2014.59.2360 Journal of Clinical Oncology 33, no. 18 (June 20, 2015) 2100-2105.