ACR Appropriateness Criteria® on Nonsurgical Treatment for Non-Small-Cell Lung Cancer: Poor Performance Status or Palliative Intent

Kenneth E. Rosenzweig, Benjamin Movsas, Jeff Bradley, Richard M. Gewanter, Ramesh S. Gopal, Ritsuko U. Komaki, Feng Ming Kong, Hoon Ku Lee, Richard H. Feins, Corey J. Langer

Research output: Contribution to journalReview article

8 Scopus citations

Abstract

Radiation therapy (RT) plays a major role in the definitive treatment of patients with non-small-cell lung cancer who are unable to tolerate surgery. Radiation therapy alone is used primarily for early-stage (stages I and II) patients. Higher doses of RT (>65 Gy) seem to improve outcomes, and modern techniques such as stereotactic body RT have been very promising. For patients with locally advanced disease (stages IIIA and IIIB), concurrent chemotherapy and RT remains the standard of care. However, many patients cannot tolerate the regimen because of its toxicity. Sequential chemotherapy followed by RT is used in these situations. Radiation therapy alone is used for the rare patient who cannot tolerate the use of any chemotherapy because of comorbid conditions. Palliative external-beam RT is useful for patients with metastatic disease, causing symptoms such as dyspnea, cough, hemoptysis, postobstructive pneumonia, and pain. Hypofractionation has been attempted as a means to provide more rapid and convenient symptom relief, but results from clinical trials are conflicting on whether it is an improvement over standard palliative fractionation. Endobronchial brachytherapy provides relief for patients with endobronchial lesions causing obstruction or hemoptysis. Palliative chemotherapy improves survival and quality of life in patients with metastatic disease compared with best supportive care. Chemotherapy also improves outcomes as a second-line and third-line treatment for patients in whom previous regimens have failed. Biologic therapies such as erlotinib and bevacizumab have been incorporated into every phase of chemotherapy with good results.

Original languageEnglish (US)
Pages (from-to)85-95
Number of pages11
JournalJournal of the American College of Radiology
Volume6
Issue number2
DOIs
StatePublished - Jan 1 2009

Keywords

  • ACR
  • chemotherapy
  • palliation
  • performance status
  • radiation therapy
  • radiotherapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Rosenzweig, K. E., Movsas, B., Bradley, J., Gewanter, R. M., Gopal, R. S., Komaki, R. U., Kong, F. M., Lee, H. K., Feins, R. H., & Langer, C. J. (2009). ACR Appropriateness Criteria® on Nonsurgical Treatment for Non-Small-Cell Lung Cancer: Poor Performance Status or Palliative Intent. Journal of the American College of Radiology, 6(2), 85-95. https://doi.org/10.1016/j.jacr.2008.11.001