Guidelines
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 24, 2022; 13(4): 237-266
Published online Apr 24, 2022. doi: 10.5306/wjco.v13.i4.237
GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer
Núria Rodríguez De Dios, Arturo Navarro-Martin, Cristina Cigarral, Rodolfo Chicas-Sett, Rafael García, Virginia Garcia, Jose Antonio Gonzalez, Susana Gonzalo, Mauricio Murcia-Mejía, Rogelio Robaina, Amalia Sotoca, Carmen Vallejo, German Valtueña, Felipe Couñago
Núria Rodríguez De Dios, Department of Radiation Oncology, Hospital del Mar, Barcelona 08003, Spain
Núria Rodríguez De Dios, Radiation Oncology Research Group, Hospital Del Mar Medical Research Institution, Barcelona 08003, Spain
Núria Rodríguez De Dios, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona 08003, Spain
Arturo Navarro-Martin, Department of Radiation Oncology, Thoracic Malignancies Unit, Hospital Duran i Reynals. ICO, L´Hospitalet de L, Lobregat 08908, Spain
Cristina Cigarral, Department of Radiation Oncology, Hospital Clínico de Salamanca, Salamanca 37007, Spain
Rodolfo Chicas-Sett, Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
Rafael García, Amalia Sotoca, Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
Virginia Garcia, Rogelio Robaina, Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
Jose Antonio Gonzalez, Department of Radiation Oncology, Genesis Care-Spain, Sevilla 41092, Spain
Susana Gonzalo, Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
Mauricio Murcia-Mejía, Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus, Reus 43204, Tarragona, Spain
Carmen Vallejo, Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
German Valtueña, Department of Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza 50009, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
Felipe Couñago, Department of Clinical, Universidad Europea, Madrid 28670, Spain
Author contributions: All the authors contributed equally to this work.
Conflict-of-interest statement: Rodríguez De Dios N reports personal fees from AstraZeneca, and Siemens Healthcare outside the submitted work. Couñago F reports personal fees from Astellas Pharma and AstraZeneca outside the submitted work. All other authors declare no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Núria Rodríguez De Dios, PhD, Associate Professor, Staff Physician, Department of Radiation Oncology, Hospital del Mar, Passeig Maritim de la Barceloneta 25, 29, Barcelona 08003, Spain. nrodriguez@psmar.cat
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: July 27, 2021
Revised: August 27, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: April 24, 2022
Processing time: 396 Days and 21.2 Hours
Abstract

Non-small cell lung cancer (NSCLC) is a heterogeneous disease accounting for approximately 85% of all lung cancers. Only 17% of patients are diagnosed at an early stage. Treatment is multidisciplinary and radiotherapy plays a key role in all stages of the disease. More than 50% of patients with NSCLC are treated with radiotherapy (curative-intent or palliative). Technological advances-including highly conformal radiotherapy techniques, new immobilization and respiratory control systems, and precision image verification systems-allow clinicians to individualize treatment to maximize tumor control while minimizing treatment-related toxicity. Novel therapeutic regimens such as moderate hypofractionation and advanced techniques such as stereotactic body radiotherapy (SBRT) have reduced the number of radiotherapy sessions. The integration of SBRT into routine clinical practice has radically altered treatment of early-stage disease. SBRT also plays an increasingly important role in oligometastatic disease. The aim of the present guidelines is to review the role of radiotherapy in the treatment of localized, locally-advanced, and metastatic NSCLC. We review the main radiotherapy techniques and clarify the role of radiotherapy in routine clinical practice. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.

Keywords: Radiotherapy; Non-small cell lung cancer; Guidelines; Stereotactic radiation therapy; Hypofractionated radiation; Oligometastasis

Core Tip: Radiotherapy is a critical component of multi-modality treatment of non-small-cell lung cancer (NSCLC). This guideline provides recommendations on the use of radiation therapy to treat patients with different stages of NSCLC. Our goal is to promote medical knowledge among physicians and improve health-care quality on these patients. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.