ACR Appropriateness Criteria® on Nonsurgical Treatment for Non-Small-Cell Lung Cancer: Poor Performance Status or Palliative Intent

Kenneth E. Rosenzweig, Benjamin Movsas, Jeff Bradley, Richard M. Gewanter, Ramesh S. Gopal, Ritsuko U. Komaki, Feng Ming Kong, Hoon Ku Lee, Richard H. Feins, Corey J. Langer

    Research output: Contribution to journalReview articlepeer-review

    10 Scopus citations


    Radiation therapy (RT) plays a major role in the definitive treatment of patients with non-small-cell lung cancer who are unable to tolerate surgery. Radiation therapy alone is used primarily for early-stage (stages I and II) patients. Higher doses of RT (>65 Gy) seem to improve outcomes, and modern techniques such as stereotactic body RT have been very promising. For patients with locally advanced disease (stages IIIA and IIIB), concurrent chemotherapy and RT remains the standard of care. However, many patients cannot tolerate the regimen because of its toxicity. Sequential chemotherapy followed by RT is used in these situations. Radiation therapy alone is used for the rare patient who cannot tolerate the use of any chemotherapy because of comorbid conditions. Palliative external-beam RT is useful for patients with metastatic disease, causing symptoms such as dyspnea, cough, hemoptysis, postobstructive pneumonia, and pain. Hypofractionation has been attempted as a means to provide more rapid and convenient symptom relief, but results from clinical trials are conflicting on whether it is an improvement over standard palliative fractionation. Endobronchial brachytherapy provides relief for patients with endobronchial lesions causing obstruction or hemoptysis. Palliative chemotherapy improves survival and quality of life in patients with metastatic disease compared with best supportive care. Chemotherapy also improves outcomes as a second-line and third-line treatment for patients in whom previous regimens have failed. Biologic therapies such as erlotinib and bevacizumab have been incorporated into every phase of chemotherapy with good results.

    Original languageEnglish
    Pages (from-to)85-95
    Number of pages11
    JournalJournal of the American College of Radiology
    Issue number2
    StatePublished - Feb 2009


    • ACR
    • chemotherapy
    • palliation
    • performance status
    • radiation therapy
    • radiotherapy


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