Updated guidelines from American Society for Radiation Oncology recommend concurrent chemotherapy with radiation therapy for the treatment of patients with incurable stage III non-small cell lung cancer who have an expected lifespan of at least 3 months and are eligible for chemotherapy.
“The primary question we faced with this revision was whether providers can enhance the impact of moderate, palliative doses of radiation by introducing additional therapy,” Benjamin Moeller, MD, PhD, radiation oncologist at Levine Cancer Institute of Carolinas HealthCare Network and chair of the guideline task force, said in an accompanying press release. “Patients in this setting typically receive 2 to 3 weeks of daily radiation, during which they might expect to have 1 to 2 weeks of clinically significant, treatment-related side effects — most commonly inflammation of the esophagus. Following treatment, however, these patients experience a more robust and durable stabilization of their quality of life, including less pain and fewer symptoms.”
Moeller and colleagues performed a systematic review of 31 randomized controlled trials, prospective studies and meta-analyses published from March 2010 through July 2016.
The updated guidelines state that certain patients with stage III NSCLC — those who are ineligible for curative therapy but eligible for chemotherapy, have an ECOG performance status of 0 to 2 and are expected to live at least 3 months — are likely to benefit from concurrent chemotherapy and radiation therapy.
Insufficient evidence exists to support chemoradiotherapy among all other patients with incurable NSCLC, including patients with stage IV disease. The task force also did not recommend combined treatment outside of clinical trials and multi-institutional registries.
The researchers recommended use of platinum-containing doublets for chemotherapy and that clinicians should use a moderately hypofractionated approach, defined as daily doses of 280 cGy to 300 cGy per fraction to a total of 3,000 cGy or 4,200 cGy.
The update did not revise recommendations for radiation dosing or the role of brachytherapy, because the evidence in the literature review did not directly address either of these.
“Optimal palliation for patients with incurable NSCLC requires coordinated interdisciplinary care,” the researchers wrote. “Recent data establish a rationale for concurrent chemotherapy with palliative thoracic external beam radiation therapy for a well-defined subset: those with incurable stage III NSCLC who are candidates for chemotherapy.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.