American radium society appropriate use criteria for unresectable locally advanced non–small cell lung cancer Journal Article
| Authors: | Rodrigues, G.; Higgins, K. A.; Rimner, A.; Amini, A.; Chang, J. Y.; Chun, S. G.; Donington, J.; Edelman, M. J.; Gubens, M. A.; Iyengar, P.; Movsas, B.; Ning, M. S.; Park, H. S.; Wolf, A.; Simone, C. B. 2nd |
| Article Title: | American radium society appropriate use criteria for unresectable locally advanced non–small cell lung cancer |
| Abstract: | Importance: The treatment of locally advanced non–small cell lung cancer (LA-NSCLC) has been informed by more than 5 decades of clinical trials and other relevant literature. However, controversies remain regarding the application of various radiation and systemic therapies in commonly encountered clinical scenarios. Objective: To develop case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable LA-NSCLC. Evidence Review: The American Radium Society (ARS) Appropriate Use Criteria (AUC) Thoracic Committee guideline is an evidence-based consensus document assessing various clinical scenarios associated with LA-NSCLC. A systematic review of the literature with evidence ratings was conducted to inform the appropriateness of treatment recommendations by the ARS AUC Thoracic Committee for the management of unresectable LA-NSCLC. Findings: Treatment appropriateness of a variety of LA-NSCLC scenarios was assessed by a consensus-based modified Delphi approach using a range of 3 points to 9 points to denote consensus agreement. Committee recommendations were vetted by the ARS AUC Executive Committee and a 2-week public comment period before official approval and adoption. Standard of care management of good prognosis LA-NSCLC consists of combined concurrent radical (60-70 Gy) platinum-based chemoradiation followed by consolidation durvalumab immunotherapy (for patients without progression). Planning and delivery of locally advanced lung cancer radiotherapy usually should be performed using intensity-modulated radiotherapy techniques. A variety of palliative and radical fractionation schedules are available to treat patients with poor performance and/or pulmonary status. The salvage therapy for a local recurrence after successful primary management is complex and likely requires both multidisciplinary input and shared decision-making with the patient. Conclusions and Relevance: Evidence-based guidance on the management of various unresectable LA-NSCLC scenarios is provided by the ARS AUC to optimize multidisciplinary patient care for this challenging patient population. This Special Communication discusses case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable locally advanced non–small cell lung cancer (NSCLC). |
| Keywords: | united states; consensus; tyrosine kinase inhibitors; immunotherapy; delphi technique; decision making; functional status; committees; chemotherapy, cancer; practice guidelines; multidisciplinary care team; epidermal growth factor receptors; professional practice, evidence-based; carcinoma, non-small-cell lung -- radiotherapy; radium -- therapeutic use; medical organizations -- united states |
| Journal Title: | JAMA Oncology |
| Volume: | 10 |
| Issue: | 6 |
| ISSN: | 2374-2437 |
| Publisher: | American Medical Association |
| Date Published: | 2024-06-01 |
| Start Page: | 799 |
| End Page: | 806 |
| Language: | English |
| DOI: | 10.1001/jamaoncol.2024.0294 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl plus with full text |
| PUBMED: | 38602670 |
| PMCID: | PMC11665040 |
| DOI/URL: | |
| Notes: | Accession Number: 178024307 -- Entry Date: 20240626 -- Revision Date: 20240626 -- Publication Type: Journal Article; practice guidelines; review; tables/charts -- Journal Subset: Peer Reviewed; USA -- Special Interest: Oncologic Care. -- Source: CINAHL Plus with Full Text |
