Elsevier

Practical Radiation Oncology

Volume 1, Issue 2, April–June 2011, Pages 60-71
Practical Radiation Oncology

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

https://doi.org/10.1016/j.prro.2011.01.005Get rights and content
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open access

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.

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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 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 Astra Zeneca. 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.