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Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer: AmericanSociety of Clinical Oncology Endorsement of the American Society for Radiation OncologyEvidence-Based Guideline.
Schneider BJ1, Daly ME1, Kennedy EB1, Antonoff MB1, Broderick S1, Feldman J1, Jolly S1, Meyers B1, Rocco G1, Rusthoven C1, Slotman BJ1, Sterman DH1, Stiles BM1.
Author information
1
Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY.

Abstract

Purpose

The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on treatment with stereotacticbody radiotherapy (SBRT) for patients with early-stage non-small-cell lung cancer. ASCO has a policy and set of procedures for endorsing and/or adapting clinical practice guidelines that have been developed by other professional organizations.

Methods

The ASTRO Evidence-Based Guideline for Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer was reviewed for developmental rigor by methodologists. An ASCO Expert Panel updated the literature search and reviewed the guideline content and recommendations.

Results

The ASCO Expert Panel determined that the recommendations from the ASTRO guideline, published in 2017, are clear, thorough, and based on the most relevant scientific evidence. ASCO statements and minor modifications were added to enhance the applicability of the ASTRO guideline for the broader ASCO audience. Recommendations For standard operative risk patients with stage I NSCLC, SBRT is not recommended outside of a clinical trial. Lobectomy with systematic lymph node evaluation remains the recommended treatment, although a sublobar resection may be considered in select clinical scenarios. Recommendations are provided regarding the use of SBRT in high operative risk patients and for inoperative patients, including in challenging scenarios where tumors are: centrally located, > 5 cm in diameter, lacking tissue diagnosis, synchronous primary or multifocal, second primary after pneumonectomy, proximal to or involved with mediastinal structures, abutting the chest wall, or recurring after previous treatment. Qualifying statements are included to provide further guidance for implementation, and the importance of a discussion of treatment options among members of the multidisciplinary cancer care team is emphasized. Additional information is available at: www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .