ARLINGTON, Va., April 4, 2018 - The American Society for Radiation Oncology (ASTRO) today issued an update to its clinical guideline for the use of palliative-intent radiation therapy for patients with incurable non-small cell lung cancer (NSCLC). Reflecting new evidence from randomized clinical trials, the guideline now recommends the addition of concurrent chemotherapy to radiation therapy for certain patients with incurable stage III NSCLC, including those who are able to tolerate chemotherapy and have a life expectancy longer than three months.
Nearly 90 percent of lung cancer diagnoses are NSCLC cases, and more than half of NSCLC patients are diagnosed with locally advanced (stage III) or metastatic (stage IV) disease. Most patients who are diagnosed with incurableNSCLC receive palliative-intent therapy, where the primary goal is to improve quality of life by relieving pain and other symptoms. Palliative radiation therapy can alleviate symptoms of lung cancer including chest pain, cough, labored or obstructed breathing and coughing up blood. It also improves overall quality of life for many patients.
"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," said Benjamin Moeller, MD, PhD, chair of the guideline task force and a radiation oncologist at the Levine Cancer Institute in Charlotte, North Carolina.
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"Patients in this setting typically receive two to three weeks of daily radiation, during which they might expect to have one to two 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."
The recommendations update the existing 2011 ASTRO guideline, which stated that there was no added benefit of concurrent chemoradiation in the palliation of lung cancer symptoms. Full recommendations and supporting evidence are provided in the full-text guideline; key recommendations are as follows:
Eligibility for concurrent chemoradiation
--Patients who are likely to benefit more from concurrent chemotherapy and radiation therapy than from either modality alone include those with (1) stage III NSCLC disease, who are (2) not eligible for curative-intent therapy but are (3) candidates for chemotherapy, (4) have an ECOG Performance Status between zero and two and (5) have a life expectancy of at least three months.
