Updated ASTRO Guideline Focuses on Palliative Radiotherapy for Lung Cancer
Posted: Wednesday, May 23, 2018
The American Society for Radiation Oncology (ASTRO) has issued an update to its clinical guideline for the use of palliative thoracic external-beam radiation therapy (EBRT) for patients with incurable non–small cell lung cancer (NSCLC). Reflecting new evidence from recent randomized clinical trials, the guideline now supports the use of concurrent chemotherapy with palliative thoracic EBRT for patients with incurable stage III NSCLC who are candidates for chemotherapy. For all other patients with incurable NSCLC, data remain insufficient to support this treatment strategy.
The recommendations update the existing 2011 ASTRO guideline, which stated there was no added benefit of concurrent chemoradiation in the palliation of lung cancer symptoms. The guideline update was based on a systematic literature review of studies published from March 2010 through July 2016. A total of 113 references were reviewed, with 31 randomized controlled trials, meta-analyses, and prospective studies included.
In terms of the role of chemotherapy administered concurrently with radiation for the palliation of lung cancer, the task force recommended this approach over either modality alone for those with stage III NSCLC considered unsuitable for curative therapy who met the following requirements: (1) candidate for chemotherapy; (2) Eastern Cooperative Oncology Group performance status of 0 to 2; and (3) a life expectancy of at least 3 months. As for palliation of patients with stage IV NSCLC, the task force did not recommend the routine use of concurrent thoracic chemoradiation; “the practice should remain primarily reserved for clinical trials or multi-institutional registries.”
Full recommendations and supporting evidence were published in Practical Radiation Oncology.