Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO/ESTRO Clinical Practice Guideline

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Puneeth Iyengar
  • Sean All
  • Mark F. Berry
  • Thomas P. Boike
  • Lisa Bradfield
  • Anne Marie C. Dingemans
  • Jill Feldman
  • Daniel R. Gomez
  • Paul J. Hesketh
  • Salma K. Jabbour
  • Melenda Jeter
  • Yolande Lievens
  • Fiona McDonald
  • Bradford A. Perez
  • Umberto Ricardi
  • Enrico Ruffini
  • Dirk De Ruysscher
  • Hina Saeed
  • Bryan J. Schneider
  • Suresh Senan
  • Joachim Widder
  • Matthias Guckenberger

Purpose: This joint guideline by American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) was initiated to review evidence and provide recommendations regarding the use of local therapy in the management of extracranial oligometastatic non-small cell lung cancer (NSCLC). Local therapy is defined as the comprehensive treatment of all known cancer—primary tumor, regional nodal metastases, and metastases—with definitive intent. Methods: ASTRO and ESTRO convened a task force to address 5 key questions focused on the use of local (radiation, surgery, other ablative methods) and systemic therapy in the management of oligometastatic NSCLC. The questions address clinical scenarios for using local therapy, sequencing and timing when integrating local with systemic therapies, radiation techniques critical for oligometastatic disease targeting and treatment delivery, and the role of local therapy for oligoprogression or recurrent disease. Recommendations were based on a systematic literature review and created using ASTRO guidelines methodology. Results: Based on the lack of significant randomized phase 3 trials, a patient-centered, multidisciplinary approach was strongly recommended for all decision-making regarding potential treatment. Integration of definitive local therapy was only relevant if technically feasible and clinically safe to all disease sites, defined as 5 or fewer distinct sites. Conditional recommendations were given for definitive local therapies in synchronous, metachronous, oligopersistent, and oligoprogressive conditions for extracranial disease. Radiation and surgery were the only primary definitive local therapy modalities recommended for use in the management of patients with oligometastatic disease, with indications provided for choosing one over the other. Sequencing recommendations were provided for systemic and local therapy integration. Finally, multiple recommendations were provided for the optimal technical use of hypofractionated radiation or stereotactic body radiation therapy as definitive local therapy, including dose and fractionation. Conclusions: Presently, data regarding clinical benefits of local therapy on overall and other survival outcomes is still sparse for oligometastatic NSCLC. However, with rapidly evolving data being generated supporting local therapy in oligometastatic NSCLC, this guideline attempted to frame recommendations as a function of the quality of data available to make decisions in a multidisciplinary approach incorporating patient goals and tolerances.

OriginalsprogEngelsk
TidsskriftPractical Radiation Oncology
Vol/bind13
Udgave nummer5
Sider (fra-til)393-412
Antal sider20
ISSN1879-8500
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Source of support: This work was funded by the American Society for Radiation Oncology.

Publisher Copyright:
© 2023 American Society for Radiation Oncology

ID: 363359244