title: Adjuvant radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline.
abstract: OBJECTIVE
  To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion.
  
  
  METHODS
  A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations.
  
  
  RESULTS
  For patients who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized.
  
  
  CONCLUSIONS
  A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions.
authors.affiliation: Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. Electronic address: george.rodrigues@lhsc.on.ca.
authors.forename: George
authors.initials: G
authors.lastname: Rodrigues
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas.
authors.forename: Hak
authors.initials: H
authors.lastname: Choy
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bradley
authors.affiliation: Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
authors.affiliation: Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bogart
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gore
authors.affiliation: Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Corey
authors.initials: C
authors.lastname: Langer
authors.affiliation: Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Louie
authors.affiliation: Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lutz
authors.affiliation: Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Maria
authors.initials: M
authors.lastname: Werner-Wasik
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Gregory M M
authors.initials: GMM
authors.lastname: Videtic
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000601:surgery; D032921:Consensus; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D020360:Neoadjuvant Therapy; D011182:Postoperative Care; D011300:Preoperative Care; D018787:Radiation Oncology / Q000592:standards; D018714:Radiotherapy, Adjuvant / Q000592:standards; D012958:Societies, Scientific; D014481:United States