American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

Stephen G. Chun; Charles B. Simone; Arya Amini; Indrin J. Chetty; Jessica Donington; Martin J. Edelman; Kristin A. Higgins; Larry L. Kestin; Benjamin Movsas; George B. Rodrigues; Kenneth E. Rosenzweig; Ben J. Slotman; Igor I. Rybkin; Andrea Wolf; Joe Y. Chang

doi:10.1016/j.jtho.2020.10.020

American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

Stephen G. Chun^*, Charles B. Simone, Arya Amini, Indrin J. Chetty, Jessica Donington, Martin J. Edelman, Kristin A. Higgins, Larry L. Kestin, Benjamin Movsas, George B. Rodrigues, Kenneth E. Rosenzweig, Ben J. Slotman, Igor I. Rybkin, Andrea Wolf, Joe Y. Chang

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. Methods: The ARS AUC are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. Results: The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1–directed immune therapy should not be routinely administered outside the context of clinical trials at this time. Conclusions: The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.

Original language	English
Pages (from-to)	66-75
Number of pages	10
Journal	Journal of Thoracic Oncology
Volume	16
Issue number	1
DOIs	https://doi.org/10.1016/j.jtho.2020.10.020
Publication status	Published - 1 Jan 2021

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10.1016/j.jtho.2020.10.020

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Chun, S. G., Simone, C. B., Amini, A., Chetty, I. J., Donington, J., Edelman, M. J., Higgins, K. A., Kestin, L. L., Movsas, B., Rodrigues, G. B., Rosenzweig, K. E., Slotman, B. J., Rybkin, I. I., Wolf, A., & Chang, J. Y. (2021). American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020. Journal of Thoracic Oncology, 16(1), 66-75. https://doi.org/10.1016/j.jtho.2020.10.020

@article{d8aaca6cad3841708e30214797c183cc,

title = "American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020",

abstract = "Introduction: Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. Methods: The ARS AUC are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. Results: The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1–directed immune therapy should not be routinely administered outside the context of clinical trials at this time. Conclusions: The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.",

keywords = "ARS, AUC, Limited-stage SCLC, Lung cancer",

author = "Chun, {Stephen G.} and Simone, {Charles B.} and Arya Amini and Chetty, {Indrin J.} and Jessica Donington and Edelman, {Martin J.} and Higgins, {Kristin A.} and Kestin, {Larry L.} and Benjamin Movsas and Rodrigues, {George B.} and Rosenzweig, {Kenneth E.} and Slotman, {Ben J.} and Rybkin, {Igor I.} and Andrea Wolf and Chang, {Joe Y.}",

note = "Funding Information: Disclosure: All panelists were required to declare all conflicts of interest for the previous 36 months before initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The American Radium Society Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists before starting development of this work. Disclosures potentially relevant to the content of this guideline are as follows: Dr. Chun reports receiving consulting fees from AstraZeneca outside of the submitted work. Dr. Amini reports receiving personal fees from AstraZeneca and RefleXion outside of the submitted work. Dr. Chetty reports receiving grants from Varian Medical Systems and Philips HealthCare outside of the submitted work. Dr. Donington reports receiving personal fees from AstraZeneca, Bristol-Myers Squibb, and Genentech outside of the submitted work. Dr. Edelman reports receiving personal fees and other fees from Biomarker Strategies and GlaxoSmithKline; personal fees from Merck, Precision Oncology, WindMIL, ARMO, BerGenBio, Genzyme, Flame Biosciences, and Aptitude Health; and other fees from Takeda, Boehringer Ingelheim, AstraZeneca, Eli Lilly Oncology, Seattle Genetics, ACI Clinical, and Arrys outside of the submitted work; and has a patent pending ?Radiopharmaceutical for treatment of SSTR2-expressing cancer.? Dr. Higgins reports receiving other fees from AstraZeneca, Genentech, RefleXion Medical, and Varian during the conduct of the study. Dr. Movsas reports receiving grants from Varian Inc. and Philips Inc., and grants and personal fees from ViewRay, Inc. outside of the submitted work. Dr. Slotman reports receiving grants and personal fees from Varian Medical Systems and ViewRay, Inc. outside of the submitted work. Dr. Chang reports receiving grants from Bristol-Myers Squibb; personal fees from Varian and AstraZeneca; and other fees from Global Oncology One outside of the submitted work. The remaining authors declare no conflict of interest. Funding Information: Disclosure: All panelists were required to declare all conflicts of interest for the previous 36 months before initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The American Radium Society Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists before starting development of this work. Disclosures potentially relevant to the content of this guideline are as follows: Dr. Chun reports receiving consulting fees from AstraZeneca outside of the submitted work. Dr. Amini reports receiving personal fees from AstraZeneca and RefleXion outside of the submitted work. Dr. Chetty reports receiving grants from Varian Medical Systems and Philips HealthCare outside of the submitted work. Dr. Donington reports receiving personal fees from AstraZeneca, Bristol-Myers Squibb, and Genentech outside of the submitted work. Dr. Edelman reports receiving personal fees and other fees from Biomarker Strategies and GlaxoSmithKline; personal fees from Merck, Precision Oncology, WindMIL, ARMO, BerGenBio, Genzyme, Flame Biosciences, and Aptitude Health; and other fees from Takeda, Boehringer Ingelheim, AstraZeneca, Eli Lilly Oncology, Seattle Genetics, ACI Clinical, and Arrys outside of the submitted work; and has a patent pending “Radiopharmaceutical for treatment of SSTR2-expressing cancer.” Dr. Higgins reports receiving other fees from AstraZeneca, Genentech, RefleXion Medical, and Varian during the conduct of the study. Dr. Movsas reports receiving grants from Varian Inc. and Philips Inc., and grants and personal fees from ViewRay, Inc. outside of the submitted work. Dr. Slotman reports receiving grants and personal fees from Varian Medical Systems and ViewRay, Inc. outside of the submitted work. Dr. Chang reports receiving grants from Bristol-Myers Squibb ; personal fees from Varian and AstraZeneca; and other fees from Global Oncology One outside of the submitted work. The remaining authors declare no conflict of interest. Publisher Copyright: {\textcopyright} 2020 International Association for the Study of Lung Cancer Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.jtho.2020.10.020",

language = "English",

volume = "16",

pages = "66--75",

journal = "Journal of Thoracic Oncology",

issn = "1556-0864",

publisher = "International Association for the Study of Lung Cancer",

number = "1",

}

Chun, SG, Simone, CB, Amini, A, Chetty, IJ, Donington, J, Edelman, MJ, Higgins, KA, Kestin, LL, Movsas, B, Rodrigues, GB, Rosenzweig, KE, Slotman, BJ, Rybkin, II, Wolf, A & Chang, JY 2021, 'American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020', Journal of Thoracic Oncology, vol. 16, no. 1, pp. 66-75. https://doi.org/10.1016/j.jtho.2020.10.020

TY - JOUR

T1 - American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

AU - Chun, Stephen G.

AU - Simone, Charles B.

AU - Amini, Arya

AU - Chetty, Indrin J.

AU - Donington, Jessica

AU - Edelman, Martin J.

AU - Higgins, Kristin A.

AU - Kestin, Larry L.

AU - Movsas, Benjamin

AU - Rodrigues, George B.

AU - Rosenzweig, Kenneth E.

AU - Slotman, Ben J.

AU - Rybkin, Igor I.

AU - Wolf, Andrea

AU - Chang, Joe Y.

N1 - Funding Information: Disclosure: All panelists were required to declare all conflicts of interest for the previous 36 months before initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The American Radium Society Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists before starting development of this work. Disclosures potentially relevant to the content of this guideline are as follows: Dr. Chun reports receiving consulting fees from AstraZeneca outside of the submitted work. Dr. Amini reports receiving personal fees from AstraZeneca and RefleXion outside of the submitted work. Dr. Chetty reports receiving grants from Varian Medical Systems and Philips HealthCare outside of the submitted work. Dr. Donington reports receiving personal fees from AstraZeneca, Bristol-Myers Squibb, and Genentech outside of the submitted work. Dr. Edelman reports receiving personal fees and other fees from Biomarker Strategies and GlaxoSmithKline; personal fees from Merck, Precision Oncology, WindMIL, ARMO, BerGenBio, Genzyme, Flame Biosciences, and Aptitude Health; and other fees from Takeda, Boehringer Ingelheim, AstraZeneca, Eli Lilly Oncology, Seattle Genetics, ACI Clinical, and Arrys outside of the submitted work; and has a patent pending ?Radiopharmaceutical for treatment of SSTR2-expressing cancer.? Dr. Higgins reports receiving other fees from AstraZeneca, Genentech, RefleXion Medical, and Varian during the conduct of the study. Dr. Movsas reports receiving grants from Varian Inc. and Philips Inc., and grants and personal fees from ViewRay, Inc. outside of the submitted work. Dr. Slotman reports receiving grants and personal fees from Varian Medical Systems and ViewRay, Inc. outside of the submitted work. Dr. Chang reports receiving grants from Bristol-Myers Squibb; personal fees from Varian and AstraZeneca; and other fees from Global Oncology One outside of the submitted work. The remaining authors declare no conflict of interest. Funding Information: Disclosure: All panelists were required to declare all conflicts of interest for the previous 36 months before initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The American Radium Society Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists before starting development of this work. Disclosures potentially relevant to the content of this guideline are as follows: Dr. Chun reports receiving consulting fees from AstraZeneca outside of the submitted work. Dr. Amini reports receiving personal fees from AstraZeneca and RefleXion outside of the submitted work. Dr. Chetty reports receiving grants from Varian Medical Systems and Philips HealthCare outside of the submitted work. Dr. Donington reports receiving personal fees from AstraZeneca, Bristol-Myers Squibb, and Genentech outside of the submitted work. Dr. Edelman reports receiving personal fees and other fees from Biomarker Strategies and GlaxoSmithKline; personal fees from Merck, Precision Oncology, WindMIL, ARMO, BerGenBio, Genzyme, Flame Biosciences, and Aptitude Health; and other fees from Takeda, Boehringer Ingelheim, AstraZeneca, Eli Lilly Oncology, Seattle Genetics, ACI Clinical, and Arrys outside of the submitted work; and has a patent pending “Radiopharmaceutical for treatment of SSTR2-expressing cancer.” Dr. Higgins reports receiving other fees from AstraZeneca, Genentech, RefleXion Medical, and Varian during the conduct of the study. Dr. Movsas reports receiving grants from Varian Inc. and Philips Inc., and grants and personal fees from ViewRay, Inc. outside of the submitted work. Dr. Slotman reports receiving grants and personal fees from Varian Medical Systems and ViewRay, Inc. outside of the submitted work. Dr. Chang reports receiving grants from Bristol-Myers Squibb ; personal fees from Varian and AstraZeneca; and other fees from Global Oncology One outside of the submitted work. The remaining authors declare no conflict of interest. Publisher Copyright: © 2020 International Association for the Study of Lung Cancer Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Introduction: Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. Methods: The ARS AUC are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. Results: The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1–directed immune therapy should not be routinely administered outside the context of clinical trials at this time. Conclusions: The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.

AB - Introduction: Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. Methods: The ARS AUC are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. Results: The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1–directed immune therapy should not be routinely administered outside the context of clinical trials at this time. Conclusions: The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.

KW - ARS

KW - AUC

KW - Limited-stage SCLC

KW - Lung cancer

UR - http://www.scopus.com/inward/record.url?scp=85097056009&partnerID=8YFLogxK

U2 - 10.1016/j.jtho.2020.10.020

DO - 10.1016/j.jtho.2020.10.020

M3 - Article

C2 - 33166720

VL - 16

SP - 66

EP - 75

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

IS - 1

ER -

American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

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