Elsevier

Practical Radiation Oncology

Volume 7, Issue 5, September–October 2017, Pages 295-301
Practical Radiation Oncology

Special Article
Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline

https://doi.org/10.1016/j.prro.2017.04.014Get rights and content

Abstract

Purpose

This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC).

Methods and materials

The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in “high-risk” clinical scenarios; and (4) SBRT as salvage therapy after recurrence. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology–approved tools for grading evidence quality and recommendation strength.

Results

Although few randomized trials have been completed for SBRT, strong consensus recommendations based on extensive, consistent publications were generated for several questions, including recommendations for fractionation for central tumors and surgery versus SBRT in standard-risk medically operable patients with early-stage NSCLC. Lower quality evidence led to conditional recommendations on use of SBRT for tumors >5 cm, patients with prior pneumonectomy, T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior radiation therapy. These areas of moderate- and low-quality evidence highlight the importance of clinical trial enrollment as well as the role of prospective data registries.

Conclusions

SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.

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Supplementary material for this article (http://dx.doi.org/10.1016/j.prro.2017.04.014) can be found at www.practicalradonc.org.

Conflicts of interest. Before initiating work on this guideline, all task force members completed disclosure statements and pertinent disclosures are published within this report. Where potential conflicts are detected, remedial measures to address them are taken and noted here.

MG: honoraria and travel expenses from Elekta; CK: previous research funding from Varian; KL: stock in Pfizer and Synta Pharmaceuticals; SL: previous research funding from Elekta and previous travel expenses and honoraria from Accuray; DM: previous travel expenses from Varian, previous honoraria for Augmenix; BM: research funding and travel expenses from Varian and Philips, patents with Henry Ford Health System (no royalties received), and National Cancer Institute small business grant with Humanetics; AR: research funding from Varian, Boehringer Ingelheim, and Pfizer, previous advisory board for AstraZeneca; MR: previous travel expenses from BTG, Varian, and Elekta; RT: research funding from Varian, Accuray, and Elekta.

These disclosures were reviewed by the Guidelines Subcommittee chairs (for task force chairs), the task force chairs (for task force members), and the Conflict of Interest Review Committee. They were determined to be sufficiently managed by disclosure to the task force and in this publication.

E-mail address:[email protected] (G.M.M. Videtic).

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