ASTRO Updates Guideline for Palliative Lung Cancer Radiation Therapy

04/05/18

The American Society for Radiation Oncology (ASTRO) has provided an update to its clinical guideline for palliative-intent radiation therapy in patients with lung cancer, recommending concurrent chemotherapy for some patients with stage III disease.

A task force convened to conduct a systematic literature review on the use of concurrent chemotherapy with palliative thoracic external beam radiation therapy. The original guideline was published in 2011.

Led by Benjamin Moeller, MD, PhD, department of radiation oncology, Levine Cancer Institute (Charlotte, NC), the panel created new guideline recommendations by utilizing a predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. The guidelines will be published in Practical Radiation Oncology (online April 3, 2018; doi:10.1016/j.prro.2018.02.009).

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"The primary question we faced with this revision was whether providers can enhance the impact of moderate, palliative doses of radiation by introducing additional therapy," said Dr Moeller in a press release (April 4, 2018).

Included in the updated 2018 guidelines are the following recommendations:

  • Patients who are likely to benefit more from concurrent chemotherapy and radiation therapy than from either modality alone include those with 1) stage III non-small cell lung cancer (NSCLC), who are 2) not eligible for curative-intent therapy but are 3) candidates for chemotherapy, 4) have an ECOG Performance Status between zero and two, and 5) have a life expectancy of at least 3 months.
  • For all other patients with incurable NSCLC, including those with stage IV disease, the evidence remains insufficient to support concurrent thoracic chemoradiation; combined treatment is not recommended outside of clinical trials and multi-institutional registries.
  • For radiation therapy, a moderately hypofractionated approach with external beam radiation therapy is recommended. Higher radiation doses may not be tolerable for palliative-intent patients and lower doses may not confer a quality of life benefit. Best practice also includes minimizing unnecessary radiation dose to the esophagus.

“Optimal palliation of patients with incurable NSCLC requires coordinated interdisciplinary care,” Dr Moeller and colleagues wrote. “Recent data establish a rationale for concurrent chemotherapy with palliative thoracic external beam radiation therapy for a well-defined subset of patients with incurable stage III NSCLC.”—Zachary Bessette