Definitive and Adjuvant Radiation Therapy in Non-small Cell Lung Cancer (NSCLC)

Publication Date: March 1, 2015
Last Updated: March 14, 2022

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.

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.

There is no role for the routine use of induction chemotherapy before chemoradiotherapy.

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.

The ideal concurrent chemotherapy regimen has not been determined. The two most common regimens are cisplatin/etoposide and carboplatin/paclitaxel.

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.

Radiotherapy alone may be used for patients ineligible for combined modality treatment; it may offer better tolerability, but poorer survival.

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.

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.

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.

Recommendation Grading



Definitive and Adjuvant Radiation Therapy in Non-small Cell Lung Cancer (NSCLC)

Authoring Organization

Publication Month/Year

March 1, 2015

Last Updated Month/Year

January 10, 2024

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


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


Management, Treatment

Diseases/Conditions (MeSH)

D002289 - Carcinoma, Non-Small-Cell Lung, D018787 - Radiation Oncology, D008495 - Medical Oncology


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.

Supplemental Methodology Resources

Methodology Supplement, Methodology Supplement