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Rodrigues G, Videtic GM, Sur R, et al. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011;1(2):60-71doi: 10.1016/j.prro.2011.01.005.
Rodrigues, G., Videtic, G. M., Sur, R., Bezjak, A., Bradley, J., Hahn, C. A., Langer, C., Miller, K. L., Moeller, B. J., Rosenzweig, K., & Movsas, B. (2011). Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. Practical radiation oncology, 1(2), 60-71. https://doi.org/10.1016/j.prro.2011.01.005
Rodrigues, George, et al. "Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline." Practical radiation oncology vol. 1,2 (2011): 60-71. doi: https://doi.org/10.1016/j.prro.2011.01.005
Rodrigues G, Videtic GM, Sur R, Bezjak A, Bradley J, Hahn CA, Langer C, Miller KL, Moeller BJ, Rosenzweig K, Movsas B. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011 Apr-Jun;1(2):60-71. doi: 10.1016/j.prro.2011.01.005. Epub 2011 Apr 08. PMID: 25740118; PMCID: PMC3808743.
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Pract Radiat Oncol. 2011 Apr-Jun;1(2):60-71. doi: 10.1016/j.prro.2011.01.005. Epub 2011 Apr 08.

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline.

Practical radiation oncology

George Rodrigues, Gregory M M Videtic, Ranjan Sur, Andrea Bezjak, Jeffrey Bradley, Carol A Hahn, Corey Langer, Keith L Miller, Benjamin J Moeller, Kenneth Rosenzweig, Benjamin Movsas

Affiliations

  1. Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada. Electronic address: [email protected].
  2. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
  3. Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada.
  4. Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada.
  5. Department of Radiation Oncology, University of Washington School of Medicine, St Louis, Missouri.
  6. Department of Radiation Oncology, Duke University Medical School, Durham, North Carolina.
  7. Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
  8. Department of Radiation Oncology, 21st Century Oncology, Fort Myers, Florida.
  9. Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas.
  10. Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York.
  11. Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan.

PMID: 25740118 PMCID: PMC3808743 DOI: 10.1016/j.prro.2011.01.005

Abstract

PURPOSE: 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.

METHODS AND MATERIALS: A Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3) use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein.

RESULTS: Studies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature.

CONCLUSION: This Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas.

Copyright © 2011 2010 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved. Published by Elsevier Inc. All rights reserved.

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