GOECP/SEOR clinical recommendations for lung cancer radiotherapy during the COVID-19 pandemic

Table 6 Summary of recommendations of the main clinical guidelines and of the GOECP/SEOR for lung cancer radiotherapy during the coronavirus disease 2019 pandemic

	ESTRO-ASTRO	MSKCC	Yale radiation oncology	GOECP/SEOR
Stage I NSCLC	SBRT: 45-54 Gy in 3 fx, 48 Gy in 4 fx; Maximum hypofractionation supported, 30-34 Gy 1 fx	SBRT; Peripheral lesions: 34 Gy, 1 fx; Central tumours: 10 Gy × 5 fx; Ultracentral tumours: 7.5 Gy × 8 fx	SBRT; Peripheral lesions: 30-34 Gy, 1 fx (first option). -45 Gy in 3 fx; Central tumours: 45 Gy in 3 fx (first option); -50 Gy/5 fx; Ultracentral or very large tumours: 60-72 Gy in 15-18 fx vs 60 Gy in 8 fx	SBRT; Safe Zone: -30-34Gy, 1 fx (first option). -54 Gy in 3 fx; Peripheral Lesions: 48 Gy in 4 fx (first option); Central Tumour: 50-60 Gy in 5 fx vs 60 Gy in 8 fx
Stage III NSCLC	CRT 60-66 Gy in 30-33 fx	CRT 55 Gy in 20 fx	CRT 60 Gy in 30 fx	CRT 60-66 Gy in 30-33 fx
Stage III NSCLC; Radiotherapy Alone/sequential	60 Gy in 15 fx (33%); 60 Gy in 20 fx (27%); 60-66 Gy in 24-30 fx (2.2-2.75 Gy/d) (23%) 24; 55 Gy in 20 fx (13%)	45 Gy in 15 fx (or more hypofractionated)	52.5-60 Gy in 15 fx	55 Gy in 20 fx1 (first option); 45 Gy in 15 fx
PORT NSCLC	50-60 Gy over 5-6 wk	50 Gy in 25 fx	Delay treatment	Delay treatment
LS-SCLC	CRT 60-66 Gy in 30-33 fx over 6-6.5 wk, or 45 Gy in 30 fx over 3 wk using BID fractions of 1.5 Gy	-45 Gy in twice daily 1.5 Gy (first option); -66-70 Gy in 33-35 daily fx; -45 Gy in 15 daily fx	40-42 Gy in 15 daily fx	CRT 60-66 Gy in 30-33 fx over 6-6.5 wk, or 45 Gy in 30 fx over 3 wk using BID fractions of 1.5 Gy1
PCI; SCLC	LS-SCLC: 25 Gy in 10 fx over 2 wk	LS-SCLC: 25 Gy in 10 fx; ES-SCLC: 20 Gy in 5 fractions or MRI surveillance	Delay treatment	LS-SCLC: 25Gy in 10 fx; ES-SCLC: MRI surveillance (if available)
Palliative	Preferred fractionation schedule: 20 Gy in 5 fx (30%); 17 Gy in 2 fx (37%); 8-10 Gy in 1fx (33%)	-20 Gy in 5 fx; -17 Gy in 2 fx; -10 Gy in 1fx	Pain or bony lesion: 8 Gy × 1 fx; Bleeding: 10 Gy × 1 fx; If single fraction not possible, hypofractionate dose to extent possible; Brain metastases can be deferred per algorithm, and treated with single fraction radiosurgery; Endobronchial obstruction: Consider 8 Gy × 1 or 17 Gy in 2 weekly fractions	Pain or bony lesion: 8 Gy × 1 fx; Bleeding: 10 Gy x 1 fx, 20 Gy × 5fx; If single fraction not possible, hypofractionate dose to extent possible; Multiple brain metastases: 20 Gy × 5 fx (in favourable subgroup); MSCC: 8 Gy × 1fx

¹Selected cases, if there are resource limitations in the radiotherapy department, consider hypofractionated radiotherapy administered sequentially after chemotherapy. CRT: Chemoradiotherapy; Fx: Fraction; NSCLC: Non-small cell lung cancer; SCLC: Non-small cell lung cancer; LS: Limited stage; ES: Extensive stage; MSCC: Malignant spinal cord compression; MSKCC: Memorial sloan-kettering cancer center; PCI: Prophylactic cranial irradiation; PORT: Postoperative radiotherapy; GOECP: Oncologic Group for the Study of Lung Cancer; SEOR: Spanish Society of Radiation Oncology; SBRT: Stereotactic body radiotherapy.