American Radium Society™ Appropriate Use Criteria on Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer

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International journal of radiation oncology, biology, physics


PURPOSE: Recent randomized studies have suggested improvements in progression-free and overall survival with the addition of stereotactic body radiation therapy (SBRT, also known as stereotactic ablative radiotherapy, SABR) in oligometastatic NSCLC patients. Given the novelty and complexity of incorporating SBRT in the oligometastatic setting, the multidisciplinary American Radium Society (ARS) Lung Cancer Panel was assigned to create Appropriate Use Criteria (AUC) on SBRT as part of consolidative local therapy for oligometastatic and oligoprogressive NSCLC patients.

METHODS AND MATERIALS: A review of the current literature was conducted from January 1, 2008 to December 25, 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically search the PubMed database to retrieve a comprehensive set of relevant articles.

RESULTS: Based on representation in existing randomized trials, the panel defined the term "oligometastasis" as ≤3 metastatic deposits (not including the primary tumor) in the previously-untreated setting or after first-line systemic therapy following the initial diagnosis. "Oligoprogression" also referred to ≤3 discrete areas of progression in the setting of prior or ongoing receipt of systemic therapy. In all appropriate patients, the panel strongly recommends enrollment on a clinical trial whenever available. For oligometastatic disease, administering first-line systemic therapy followed by consolidative radiotherapy (to all sites plus the primary/nodal disease) is preferred over up-front radiotherapy. Owing to a dearth of data, the panel recommended that consolidative radiotherapy be considered on a case-by-case basis for 4-5 sites of oligometastatic disease, driver mutation-positive oligometastatic disease without progression on up-front targeted therapy, and oligoprogressive cases.

CONCLUSIONS: Although SBRT/SABR appears to be both safe and effective in treating patients with limited metastatic sites of disease, many clinical circumstances require individualized management and strong multidisciplinary discussion on account of the limited existing data.

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ePub ahead of print