Definitive and Adjuvant Radiotherapy in Locally Advanced Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline

Abstract

For curative-intent treatment of locally advanced NSCLC, concurrent chemoradiotherapy improves local control and overall survival compared with sequential chemotherapy followed by radiation. The standard dose-fractionation of radiation is 60 Gy given in 2-Gy once-daily fractions over 6 weeks. There is no role for the routine use of induction therapy before chemoradiotherapy. Current data fail to support a clear role for consolidation therapy after chemoradiotherapy; however, consolidation therapy remains an option for patients who did not receive full systemic chemotherapy doses during radiotherapy. Important questions remain about the ideal concurrent chemotherapy regimen and optimal management of patients with resectable stage III disease.

Randomized phase III PITCAP trial and meta-analysis of induction chemotherapy followed by thoracic irradiation with or without concurrent taxane-based chemotherapy in locally advanced NSCLC

“…According to international guidelines [6, [18][19][20], concurrent platinum-based chemotherapy and thoracic irradiation is the recommended treatment for locally advanced inoperable NSCLC. This recommendation is based on the results of a series of randomized studies and meta-analyses demonstrating the superiority of concurrent chemo-radiation over radiotherapy alone [21,22] and over sequential chemo-radiation [23][24][25][26] at the cost, however, of an increased toxicity [3].…”

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

“…This setting is the most controversial (28). The best candidates for preoperative RT-CT should have the following requirements: preoperatively planned lobectomy, no weight loss, female sex, and only one involved nodal station (28). Multidisciplinary assessment is crucial for this group of patients in order to select the proper candidate for multimodality treatment and account for comorbidities, age, location, and tumor extension.…”

“…This setting is the most controversial (28). The best candidates for preoperative RT-CT should have the following requirements: preoperatively planned lobectomy, no weight loss, female sex, and only one involved nodal station (28).…”

Cons: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with inoperable large volume stage III non-small cell lung cancer

“…Despite the failure of RTOG 0617 in the demonstration that further treatment intensification can lead to improved patient outcomes, the routine use of concurrent chemoradiation as a treatment option for fit patients with unresectable stage III NSCLC is on a solid clinical trial footing (1,2). Initially, the focus was on the development of sequential chemotherapy followed by radiotherapy.…”

“…The treatment of stage III unresectable non-small cell lung cancer (NSCLC) remains a significant challenge despite approximately 40 years of clinical trial activity in this patient population (1,2). Medical imaging, nuclear medicine, imageguided radiation treatment, radiation treatment delivery, and systemic treatments all have significantly improved the medical care of these patients (3).…”