ASCO Endorses ASTRO Guideline on Stereotactic Body Radiotherapy for Early-Stage NSCLC

Key Points

  • ASCO endorses the ASTRO guideline on stereotactic body radiotherapy for early-stage NSCLC, with minor changes and the addition of qualifying statements.
  • Stereotactic body radiotherapy is not recommended outside of a clinical trial for standard operative–risk patients with stage I NSCLC, with lobectomy and systematic lymph node evaluation remaining the recommended treatment.

As reported in the Journal of Clinical Oncologyby Bryan J. Schneider, MD, of the University of Michigan, Ann Arbor, and colleagues, ASCO has endorsed the recently released American Society for Radiation Oncology (ASTRO) evidence-based guideline on stereotactic body radiotherapy in early-stage (T1–2, N0) non–small cell lung cancer (NSCLC). Endorsement was based on an updated literature search and review of guideline content by an ASCO expert panel co-chaired by Dr. Schneider and Brendon M. Stiles, MD, of Weill Cornell Medical College.

In brief, the guideline states that stereotactic body radiotherapy is not recommended outside of a clinical trial for standard operative–risk patients with stage I NSCLC. Lobectomy with systematic lymph node evaluation remains the recommended treatment, although sublobar resection can be considered in select clinical scenarios.

Specific recommendations cover the use of stereotactic body radiotherapy in high operative–risk patients and for inoperative patients, including in situations in which tumors are centrally located, > 5 cm in diameter, lacking tissue diagnosis, synchronous primary or multifocal, second primary after pneumonectomy, proximal to or involved with mediastinal structures, abutting the chest wall, or recurring after previous treatment. Both ASCO and ASTRO qualifying statements are included in the full guideline to facilitate the implementation of recommendations. The importance of discussion of treatment options among members of the multidisciplinary cancer care team is emphasized.

Additional information is available at: and The ASTRO guideline can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.




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