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Pract Radiat Oncol. 2015 May-Jun;5(3):141-8. doi: 10.1016/j.prro.2015.02.012.

Definitive radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline.

Author information

1
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. Electronic address: george.rodrigues@lhsc.on.ca.
2
Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas.
3
Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
4
Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York.
5
Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York.
6
Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
7
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
8
Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
9
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
10
Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio.
11
Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio.
12
Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
13
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
14
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.

Abstract

PURPOSE:

To provide guidance to physicians and patients with regard to the use of definitive external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion.

METHODS AND MATERIALS:

A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 3 systematic reviews on the following topics: (1) ideal radical RT dose fractionation for RT alone; (2) ideal radical RT dose fractionation for chemoradiation; and (3) ideal timing of radical radiation therapy with systemic chemotherapy. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations.

RESULTS:

For patients managed by RT alone, a minimum dose of 60 Gy of RT is recommended. Dose escalation beyond 60 Gy in the context of combined modality concurrent chemoradiation has not been found to be associated with any clinical benefits. In the context of combined modality therapy, chemotherapy and radiation should ideally be given concurrently to maximize survival, local control, and disease response rate.

CONCLUSIONS:

A consensus and evidence-based clinical practice guideline for the definitive radiotherapeutic management of LA NSCLC has been created that addresses 3 important questions.

PMID:
25957184
DOI:
10.1016/j.prro.2015.02.012
[Indexed for MEDLINE]

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