Benjamin Moeller1, Ehsan H Balagamwala2, Aileen Chen3, Kimberly M Creach4, Giuseppe Giaccone5, Matthew Koshy6, Sandra Zaky7, George Rodrigues8. 1. Department of Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina. Electronic address: benjamin.moeller@carolinashealthcare.org. 2. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 3. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 4. Department of Radiation Oncology, Mercy Clinic, Springfield, Missouri. 5. Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. 6. Department of Radiation Oncology, University of Chicago, Chicago, Illinois. 7. Department of Radiation Oncology, Stanford Radiation Oncology Center, Turlock, California. 8. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Abstract
PURPOSE: To revise the recommendation on the use of concurrent chemotherapy (CC) with palliative thoracic external beam radiation therapy (EBRT) made in the original 2011 American Society for Radiation Oncology guideline on palliative thoracic radiation for lung cancer. METHODS AND MATERIALS: Based on a systematic PubMed search showing new evidence for this key question, the task force felt an update was merited. 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 clinical trials address the question of CC combined with palliative thoracic EBRT for non-small cell lung cancer (NSCLC), a strong consensus was reached among the task force on recommendations for incurable stage III and IV NSCLC. For patients with stage III NSCLC deemed unsuitable for curative therapy but who are (1) candidates for chemotherapy, (2) have an Eastern Cooperative Oncology Group PS of 0 to 2, and (3) have a life expectancy of at least 3 months, administration of a platinum-containing chemotherapy doublet concurrently with moderately hypofractionated palliative thoracic radiation therapy is recommended over treatment with either modality alone. For patients with stage IV NSCLC, routine use of concurrent thoracic chemoradiation is not recommended. CONCLUSIONS: Optimal palliation of patients with incurable NSCLC requires coordinated interdisciplinary care. Recent data establish a rationale for CC with palliative thoracic EBRT for a well-defined subset of patients with incurable stage III NSCLC. For all other patients with incurable NSCLC, data remain insufficient to support this treatment approach.
PURPOSE: To revise the recommendation on the use of concurrent chemotherapy (CC) with palliative thoracic external beam radiation therapy (EBRT) made in the original 2011 American Society for Radiation Oncology guideline on palliative thoracic radiation for lung cancer. METHODS AND MATERIALS: Based on a systematic PubMed search showing new evidence for this key question, the task force felt an update was merited. 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 clinical trials address the question of CC combined with palliative thoracic EBRT for non-small cell lung cancer (NSCLC), a strong consensus was reached among the task force on recommendations for incurable stage III and IV NSCLC. For patients with stage III NSCLC deemed unsuitable for curative therapy but who are (1) candidates for chemotherapy, (2) have an Eastern Cooperative Oncology Group PS of 0 to 2, and (3) have a life expectancy of at least 3 months, administration of a platinum-containing chemotherapy doublet concurrently with moderately hypofractionated palliative thoracic radiation therapy is recommended over treatment with either modality alone. For patients with stage IV NSCLC, routine use of concurrent thoracic chemoradiation is not recommended. CONCLUSIONS: Optimal palliation of patients with incurable NSCLC requires coordinated interdisciplinary care. Recent data establish a rationale for CC with palliative thoracic EBRT for a well-defined subset of patients with incurable stage III NSCLC. For all other patients with incurable NSCLC, data remain insufficient to support this treatment approach.
Authors: Ruchika Gutt; Sheetal Malhotra; Drew Moghanaki; Alice V Cheuk; Lori Hoffman-Hogg; Maria Kelly; Helen Fosmire; George Dawson Journal: Fed Pract Date: 2020-05