American Society for Radiation Oncology

View all recommendations from this society

Released September 15, 2014

Don’t routinely offer radiation therapy for patients who have resected non-small-cell lung cancer (NSCLC) negative margins N0-1 disease.

Patients with early stage NSCLC have several management options following surgery. These options include: observation, chemotherapy and radiotherapy.

Two meta-analysis studies of post-operative radiotherapy in early NSCLC with node negative or N1 disease suggest increased side effects with no benefit for disease-free survival or overall survival compared to observation.

Patients with positive margins following surgery may benefit from post-operative radiotherapy to improve local control regardless of status of their nodal disease.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1–5: Following approval of the participation of the American Society for Radiation Oncology (ASTRO) in the Choosing Wisely campaign, a survey was sent to ASTRO committees and panels related to health policy, government relations, and clinical affairs and quality in order to identify potential items for inclusion in the list. A work group, comprised of seven physicians drawn from these three areas, was also selected and convened. The work group members were asked to pick their top eight items from the total of 34 topics that had been suggested in the initial survey. The results were tabulated and a list of the highest scoring items generated, creating a short list of 13 draft items.

Three conference calls were subsequently held to further refine the list and finalize the wording of the items based on input from ASTRO’s Board of Directors. A literature review was conducted for each topic by ASTRO staff and each work group member took the lead on writing text and selecting references for one or more draft items. The final items for submission were selected by ASTRO’s Board of Directors. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

6–10: In January 2014, the American Society for Radiation Oncology (ASTRO) formed a group to develop its second Choosing Wisely list, which included representatives from health policy, government relations, and clinical affairs and quality. The work group began by narrowing a list of 28 draft concepts to nine potential Choosing Wisely items. Next, an electronic anonymous survey was sent to the ASTRO membership to rate the value and relevancy of each of the items. The survey also included an open text box for members to comment on the suggested items and to provide additional ideas for Choosing Wisely items. Based on the survey results, the work group submitted a short list of eight items to the ASTRO Board of Directors, from which the Board chose five items to move forward.

Literature reviews were conducted for the five Choosing Wisely items selected by the Board and the group drafted verbiage, bullet points and references for each item. Following a second review by the Board of Directors, one of the items was replaced with an alternate item from the short list. The final list received approval from the Board and was then submitted to the ABIM Foundation. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

Sources

Perry MC. A phase III study of surgical resection and paclitax el/carboplatin chemotherapy with or without adjuvant radiation therapy for resected stage III non-small-cell lung cancer: cancer and leukemia group B 9734. Clin Lung Cancer. 2007 Jan; 8(4):268–72.

Trodella L. Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol. 2002;62(1):11–9.

Keller SM. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIa non-small -cell lung cancer. Eastern Cooperative Oncology Group. N Engl J Med. 2000;343:1217–22.

Feng QF. A study of postoperative radiotherapy in patients with non-sm all-cell lung cancer: a randomized trial. Int J R adiat Oncol Biol Phys. 2000 Jul 1;47)4)925–9.

Mayer R. Postoperative radiotherapy in radically resected non-small-cell lung cancer. Chest 1997;112:954–9.

Rodrigues G, Choy H, Bradley J, Rosenzweig KE, Bogart J, Curran WJ Jr, Gore E, Langer C, Louie AV, Lutz S, Machtay M, Puri V, Werner-Wasik M, Videtic GM. Adjuvant radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol. 2015 May-Jun;5(3):149-55.