局部晚期非小细胞肺癌的根治性和辅助放疗：美国临床肿瘤学会临床实践指南对美国放射肿瘤学会循证临床实践指南的认可。
Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline.
机构信息
Andrea Bezjak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Gregg Franklin, New Mexico Cancer Center, Albuquerque, NM; Giuseppe Giaccone, Lombardi Cancer Center, Washington, DC; Ramaswamy Govindan, Washington University, St Louis, MO; Melissa L. Johnson, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Andreas Rimner, Memorial Sloan Kettering Cancer Center; Bryan J. Schneider, Weill Cornell Medical College, New York, NY; John Strawn, Patient Representative, Houston, TX; and Christopher G. Azzoli, Massachusetts General, Boston, MA.
出版信息
J Clin Oncol. 2015 Jun 20;33(18):2100-5. doi: 10.1200/JCO.2014.59.2360. Epub 2015 May 5.
PURPOSE
The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on external-beam radiotherapy for patients with locally advanced non-small-cell lung cancer (NSCLC). Because of its relevance to the American Society of Clinical Oncology (ASCO) membership, ASCO endorsed the guideline after applying a set of procedures and a policy that are used to critically examine and endorse guidelines developed by other guideline development organizations.
METHODS
The ASTRO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO expert panel was convened and endorsed the guideline. The ASCO guideline approval body, the Clinical Practice Guideline Committee, approved the final endorsement.
RESULTS
The recommendations from the ASTRO guideline, published in Practical Radiation Oncology, are clear, thorough, and based on the most relevant scientific evidence. The ASCO Endorsement Panel endorsed the guideline and added qualifying statements.
RECOMMENDATIONS
For curative-intent treatment of locally advanced NSCLC, concurrent chemoradiotherapy improves local control and overall survival compared with sequential chemotherapy followed by radiation. The standard dose-fractionation of radiation is 60 Gy given in 2-Gy once-daily fractions over 6 weeks. There is no role for the routine use of induction therapy before chemoradiotherapy. Current data fail to support a clear role for consolidation therapy after chemoradiotherapy; however, consolidation therapy remains an option for patients who did not receive full systemic chemotherapy doses during radiotherapy. Important questions remain about the ideal concurrent chemotherapy regimen and optimal management of patients with resectable stage III disease.
目的
美国放射肿瘤学会（ASTRO）针对局部晚期非小细胞肺癌（NSCLC）患者的外照射放射治疗制定了一项基于证据的指南。由于该指南与美国临床肿瘤学会（ASCO）成员相关，ASCO 在应用一系列程序和政策对其他指南制定组织制定的指南进行严格审查和认可后，对该指南表示认可。
方法
ASCO 的临床专家对 ASTRO 指南进行了临床准确性审查，ASCO 的方法学家对其发展严谨性进行了审查。经审查通过，召集了一个 ASCO 专家小组对该指南进行了认可。ASCO 指南批准机构——临床实践指南委员会批准了最终认可。
结果
ASTRO 指南中发表于《实用放射肿瘤学》上的建议明确、全面，并基于最相关的科学证据。ASCO 认可小组认可了该指南，并添加了限定性陈述。
建议
对于局部晚期 NSCLC 的治愈性治疗，同期放化疗与序贯化疗后放疗相比，可改善局部控制和总生存期。放疗的标准剂量分割为 60 Gy，6 周内每天 2 Gy 分 30 次给予。在放化疗前常规应用诱导治疗没有作用。目前的数据未能明确支持放化疗后巩固治疗的作用；然而，对于在放疗期间未接受全剂量全身化疗的患者，巩固治疗仍是一种选择。关于同期化疗方案的理想选择和可切除 III 期疾病患者的最佳管理，仍存在重要问题。
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