ASCO Endorses ASTRO Guidelines on Stereotactic Body Radiotherapy for NSCLC
Posted: Friday, March 23, 2018
The American Society of Clinical Oncology (ASCO) has endorsed the recently released American Society for Radiation Oncology (ASTRO) evidence-based guideline on the use of stereotactic body radiotherapy (SBRT) in early stage (T1–2, N0) non–small cell lung cancer (NSCLC). However, an ASCO expert panel did make some recommendations to the original ASTRO-based guidelines. The expert panel was co-chaired by Bryan J. Schneider, MD, of the University of Michigan, Ann Arbor, and Brendon M. Stiles, MD, of Weill Cornell Medical College.
Some of the key recommendations suggested by the expert panel follow:
- Patients with stage I NSCLC should be evaluated by a thoracic surgeon.
- Providers should use caution when considering SBRT for central tumors.
- In patients lacking tissue confirmation, a biopsy should be obtained prior to SBRT.
- Providers should use caution when considering SBRT for tumors in close proximity to the proximal bronchial tree.
One of the potentially controversial components of the guideline is the recommendation that SBRT may be offered in select scenarios to patients lacking tissue confirmation of malignancy. Although the guideline strongly recommends obtaining tissue whenever possible, it addresses the increasingly common scenario of the frail patient for whom the procedures to obtain tissue pose prohibitive risk.
In addition, the ASCO recommendations emphasize the use of informed consent/shared decision-making with patients. A multidisciplinary approach is another key aspect of the recommendations. Finally, a consistent theme in both the original ASTRO guideline and the ASCO endorsement is providing an appropriate balance between tumor control and risk of toxicity.
