Gregory M M Videtic1, Jessica Donington2, Meredith Giuliani3, John Heinzerling4, Tomer Z Karas5, Chris R Kelsey6, Brian E Lally7, Karen Latzka8, Simon S Lo9, Drew Moghanaki10, Benjamin Movsas11, Andreas Rimner12, Michael Roach13, George Rodrigues14, Shervin M Shirvani15, Charles B Simone16, Robert Timmerman17, Megan E Daly18. 1. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 2. Department of Cardiothoracic Surgery, New York University, New York, New York. 3. Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 4. Department of Radiation Oncology, Southeast Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina. 5. Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Florida. 6. Department of Radiation Oncology, Duke University, Durham, North Carolina. 7. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Kaneohe, Hawaii. 9. Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington. 10. Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia. 11. Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan. 12. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 13. Department of Radiation Oncology, Washington University, St. Louis, Missouri. 14. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. 15. Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Arizona. 16. Department of Radiation Oncology, University of Maryland, Baltimore, Maryland. 17. Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas. 18. Department of Radiation Oncology, University of California, Davis, Sacramento, California.
Abstract
PURPOSE: This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in "high-risk" clinical scenarios; and (4) SBRT as salvage therapy after recurrence. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology-approved tools for grading evidence quality and recommendation strength. RESULTS: Although few randomized trials have been completed for SBRT, strong consensus recommendations based on extensive, consistent publications were generated for several questions, including recommendations for fractionation for central tumors and surgery versus SBRT in standard-risk medically operable patients with early-stage NSCLC. Lower quality evidence led to conditional recommendations on use of SBRT for tumors >5 cm, patients with prior pneumonectomy, T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior radiation therapy. These areas of moderate- and low-quality evidence highlight the importance of clinical trial enrollment as well as the role of prospective data registries. CONCLUSIONS: SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.
PURPOSE: This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in "high-risk" clinical scenarios; and (4) SBRT as salvage therapy after recurrence. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology-approved tools for grading evidence quality and recommendation strength. RESULTS: Although few randomized trials have been completed for SBRT, strong consensus recommendations based on extensive, consistent publications were generated for several questions, including recommendations for fractionation for central tumors and surgery versus SBRT in standard-risk medically operable patients with early-stage NSCLC. Lower quality evidence led to conditional recommendations on use of SBRT for tumors >5 cm, patients with prior pneumonectomy, T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior radiation therapy. These areas of moderate- and low-quality evidence highlight the importance of clinical trial enrollment as well as the role of prospective data registries. CONCLUSIONS: SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.
Authors: Andrea Bezjak; Rebecca Paulus; Laurie E Gaspar; Robert D Timmerman; William L Straube; William F Ryan; Yolanda I Garces; Anthony T Pu; Anurag K Singh; Gregory M Videtic; Ronald C McGarry; Puneeth Iyengar; Jason R Pantarotto; James J Urbanic; Alexander Y Sun; Megan E Daly; Inga S Grills; Paul Sperduto; Daniel P Normolle; Jeffrey D Bradley; Hak Choy Journal: J Clin Oncol Date: 2019-04-03 Impact factor: 44.544
Authors: Christopher Cao; Daniel Wang; Caroline Chung; David Tian; Andreas Rimner; James Huang; David R Jones Journal: J Thorac Cardiovasc Surg Date: 2018-09-15 Impact factor: 5.209