Evidence-based guideline for thoracic radiotherapy

Many patients whose lung cancer has spread receive radiation therapy to treat symptoms related to cancer, such as cough, shortness of breath, bronchial obstruction and chest pain. However, the exact treatment approach can vary from doctor to doctor. This variation caused the Guidelines Subcommittee of ASTRO's Clinical Affairs and Quality Committee (CAQC) to identify the use of palliative thoracic (or chest) radiation therapy as a high-priority topic needing an evidence-based guideline.

This panel was co-chaired by George Rodrigues, MD, MSc, a radiation oncologist and clinician scientist at London Health Sciences Centre in London, Ontario, Canada, and Benjamin Movsas, MD, chairman of radiation oncology at Henry Ford Health System in Detroit.

"Radiation therapy can be extremely helpful to alleviate symptoms caused by lung cancer, such as shortness of breath and chest pain," Dr. Rodrigues said.

ASTRO's Board of Directors then put together a multidisciplinary task force that was charged with reviewing and synthesizing the current evidence to develop a guideline to help radiation oncologists determine the appropriate use of external beam radiation therapy, endobronchial brachytherapy and concurrent chemotherapy for palliative intent for lung cancer patients.

The task force's main findings are:

1. Various regimens of thoracic external beam radiation therapy are very effective for palliation of symptoms, with moderately higher dose regimens associated with a modest improvement in survival for selected patients primarily with good performance status.

2. There is no evidence to recommend the use of endobronchial brachytherapy in the routine initial palliative management of lung cancer. Endobronchial brachytherapy is a type of internal radiation therapy used to treat lung cancer in or near the patient's airway.

3. There is no added benefit to patients to use chemotherapy at the same time as radiation therapy in the relief of thoracic symptoms for lung cancer patients. However, optimally integrating sequential chemotherapy and radiation therapy is important in the management of lung cancer symptoms.