TY - JOUR
T1 - Adjuvant radiation therapy in locally advanced non-small cell lung cancer
T2 - Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline
AU - Rodrigues, George
AU - Choy, Hak
AU - Bradley, Jeffrey
AU - Rosenzweig, Kenneth E.
AU - Bogart, Jeffrey
AU - Curran, Walter J.
AU - Gore, Elizabeth
AU - Langer, Corey
AU - Louie, Alexander V.
AU - Lutz, Stephen
AU - Machtay, Mitchell
AU - Puri, Varun
AU - Werner-Wasik, Maria
AU - Videtic, Gregory M.M.
N1 - Funding Information:
Conflicts of interest: Before initiation of this guideline, all members of the Task Force were required to complete disclosure statements. These statements are maintained at the American Society for Radiation Oncology (ASTRO) Headquarters in Fairfax, VA, and pertinent disclosures are published within this report. The ASTRO Conflict of Interest Disclosure Statement seeks to provide a broad disclosure of outside interests. Where a potential conflict is detected, remedial measures to address any potential conflict are taken and will be noted in the disclosure statement. The guideline chairs (G.R. and G.V.) in concert with the ASTRO guidelines subcommittee reviewed these disclosures and determined that they have no substantive impact upon the content of the manuscript. George Rodrigues, MD, PhD, has received research funding from the Ontario Institute of Cancer Research. Jeffrey Bradley, MD, has received research funding from Calypso Medical Inc. Jeffrey Bogart, MD, has received travel expense funding from Alliance Clinical Trials Cooperative Group. Hak Choy, MD, is on the advisory board for EMD Serono and Bayer; in addition, he has received research funding from Celgene and has been a consultant for Eli Lilly. Walter Curran Jr, MD, has been a consultant for Bristol Meyers Squibb. Corey Langer, MD, has received honoraria, been a consultant to, or served on the advisory board of Bristol Meyers Squibb, Eli Lilly, Genentech, Synta, and Abbott. Mitchell Machtay, MD, served as a consultant to Bristol Meyers Squibb, Eli Lilly, and Imclone. Maria Werner-Wasik, MD, received travel expense funding from Elekta Oncology.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/5
Y1 - 2015/5
N2 - Purpose: To provide guidance to physicians and patients with regard to the use of adjuvant 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 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. 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 who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized. Conclusions: A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions.
AB - Purpose: To provide guidance to physicians and patients with regard to the use of adjuvant 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 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. 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 who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized. Conclusions: A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions.
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U2 - 10.1016/j.prro.2015.02.013
DO - 10.1016/j.prro.2015.02.013
M3 - Article
C2 - 25957185
AN - SCOPUS:84947345747
SN - 1879-8500
VL - 5
SP - 149
EP - 155
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 3
ER -
