This is the current release of the guideline.

Lung cancer

To provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion

Patients with lung cancer (metastatic and locally advanced disease)

A literature search strategy was developed around the three practice guideline questions of external beam radiotherapy (EBRT) dose fractionation, indications for endobronchial brachytherapy (EBB), and use of concurrent chemotherapy (CC) with palliative intent radiotherapy. All search strategies were performed on PubMed assessing possible articles from 1966 to March 1, 2010. In particular, identification of randomized controlled trials (RCTs) or of other prospective clinical trial evaluations, if RCTs were unavailable, was the focus of the literature search. Reference lists for published practice guidelines, consensus statements, metaanalyses, and systematic reviews were cross-referenced with search strategies to ensure a complete set of manuscripts and abstracts for review by the Task Force. All abstracts were initially reviewed for an assessment of study relevance before a formal collection of manuscripts/abstracts for Task Force review and data synthesis.

The following key words and MeSH headings were used for the respective research questions: (1) What is the optimal dose/fractionation schedule for thoracic EBRT in patients with lung cancer? (radiotherapy/radiation, dosage/dose fractionation, palliative, quality of life, lung neoplasms, clinical trial, metaanalysis, RCT, and review, 174 articles); (2) What is the role of EBB alone or in conjunction with other modalities (including external beam radiation) in both the initial and salvage palliative management of lung cancer? (lung neoplasms, brachytherapy, palliative, clinical trial, metaanalysis, practice guideline, RCT, 21 articles); and (3) What is the role of chemotherapy administered concurrently (chemotherapy drug delivery on same days for some or all radiation fractions) with radiation for the palliation of lung cancer? (antineoplastic combined chemotherapy protocols/agents, palliation, lung neoplasms, radiation/radiotherapy, chemoradiation/chemoradiotherapy, 109 articles).

Review question 1: 174 articles

Review question 2: 21 articles

Review question 3: 109 articles

Not applicable

The Task Force reviewed manuscripts and created evidence tables.

The Task Force studied issues related to the use of radiotherapy in the treatment of lung cancer (LC). Task Force membership included seven recognized experts in LC radiation oncology, one in radiation oncology/pulmonology/community practice, one representative from the Guidelines Subcommittee of the American Society for Radiation Oncology Clinical Affairs and Quality Committee (CAQC), one medical oncologist, and one radiation oncology resident.

The Task Force was to review and synthesize currently available evidence to develop a clinically practical, evidence-based guideline to help radiation oncologists and LC patients to determine the appropriate use of external beam radiotherapy (EBRT), endobronchial brachytherapy (EBB), and concurrent palliative chemoradiotherapy for palliative intent LC patients. The members of the Task Force divided into three subgroups to address separate questions based upon their particular areas of expertise. Through a series of communications by conference calls and e-mail, the Task Force completed the systematic literature review, reviewed manuscripts, created evidence tables, and formulated the practice guidelines. The Task Force sought to adhere to the American Medical Association's Physician Consortium for Performance Improvement guidance for measure development and recent calls for reform of the guideline process during the preparation of this practice guideline.

Not applicable

A formal cost analysis was not performed and published analyses were not reviewed.

The initial draft of the manuscript was reviewed by three expert reviewers and then American Society for Radiation Oncology (ASTRO) legal counsel, and was subsequently placed on the ASTRO Web site (during the month of December 2010) for a period of public comment. Upon integration of this feedback, the document was then submitted to the ASTRO Board of Directors for their final review and approval in January 2011.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Appropriate use of palliative thoracic radiotherapy in patients with lung cancer

Studies suggest that higher dose/fractionation external beam radiotherapy (EBRT) regimens (e.g., 30-Gy/10-fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, primarily in patients with good performance status. As these improvements are also associated with an increase in side effects or adverse effects, such as radiation esophagitis, various shorter fractionation schedules (e.g., 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction) have been demonstrated to provide good symptomatic control with fewer side effects.

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

American Society for Radiation Oncology

American Society for Radiation Oncology (ASTRO) Task Force

Task Force Members: George Rodrigues, MD, MSc, Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada; Gregory M.M. Videtic, MD, CM, FRCPC, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio; Ranjan Sur, MD, PhD, Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada; Andrea Bezjak, MD, FRCPC, Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada; Jeffrey Bradley, MD, Department of Radiation Oncology, University of Washington School of Medicine, St Louis, Missouri; Carol A. Hahn, MD, Department of Radiation Oncology, Duke University Medical School, Durham, North Carolina; Corey Langer, MD, Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; Keith L. Miller, MD, Department of Radiation Oncology, 21st Century Oncology, Fort Myers, Florida; Benjamin J. Moeller, MD, PhD, Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas; Kenneth Rosenzweig, MD, Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York; Benjamin Movsas, MD, Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan

Conflicts of interest: Before initiation of this Guideline, all members of the Guidelines Task Group were required to complete disclosure statements. These statements are maintained at American Society for Radiation Oncology (ASTRO) Headquarters in Fairfax, VA, and pertinent disclosures are published with the 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.

Andrea Bezjak has received research funding from Glaxo and Elekta Synergy. Corey Langer has received research funding from Lilly and Genentech. Jeffrey Bradley is a consultant for Calypso Medical, and his spouse is a board member for the North American Spine Society. Benjamin Movsas has received research funding from Varian Inc, Resonant Inc, and Philips Inc. George Rodrigues has received an honorarium from AstraZeneca. Kenneth Rosenzweig has received funding from Lilly and Viewray. Dr Rosenzweig is on the scientific advisory board for Viewray and a scientific board member at American Radium Society. Ranjan Sur has received research funding from Varian Inc. The Task Group Chairs reviewed these disclosures and determined that they have no impact upon the content of the manuscript.

This is the current release of the guideline.

Electronic copies: Available from the Practical Radiation Oncology Web site .

None available

The following is available:

• Radiation therapy for lung cancer. Brochure. Fairfax (VA): American Society for Radiation Oncology; 2012. 2 p. Electronic copies: Available from the RT Answers Web site .

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

This NGC summary was completed by ECRI Institute on July 24, 2012. The information was verified by the guideline developer on August 22, 2012.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.