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Guidelines for the treatment of lung cancer using radiotherapy
Rev Assoc Med B ras 2017; 63(9):729-732 729
GUIDELINES IN FOCUS
Guidelines for the treatment of lung cancer using radiotherapy
Diretrizes para tratamento de câncer de pulmão com radioterapia
Authorship: Brazilian Society of Radiotherapy (SBR)
Participants: Michael J. Chen 1, Paulo Eduardo Novaes1, Rafael Gadia 1, Rodrigo Motta1
Final draft: August 2017
1Sociedade Brasileira de Radioterapia (SBR)
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize
procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending
on the conditions and the clinical status of each patient.
Grades of recommendation and levels
of evidence
• • A: Experimental or observational studies of higher
consistency.
• • B: Experimental or observational studies of lower
consistency.
• • C: Cases reports (non-controlled studies).
• • D: Opinion without critical evaluation, based on con-
sensus, physiological studies or animal models.
Objective
The aimof this guideline is to evaluate the most appropriate
radiotherapy technique to treat patients with lung cancer.
Description of evidence collection method
Through the elaboration of four relevant clinical questions
related to the proposed theme, we sought to present the
main evidences regarding safety, toxicity and effectiveness
of the presented radiotherapy techniques. The study
population consisted of male and female patients of all
ages with lung cancer, regardless of histological type, stag-
ing or presence of comorbidities. For this, a systematic
review of the literature was carried out in primary scien-
tific databases (Medline – PubMed; Embase – Elsevier;
Lilacs – Bireme; Cochrane Library – Record of Controlled
Trials). All articles available through April 31, 2015 were
considered. The search terms used in the research were:
((lung cancer) OR (lung carcinoma)) AND (IMRT OR in-
tensity modulation OR intensity modulated) AND (con-
ventional OR 2DOR two dimensional OR bidimensional
OR standard OR conformal OR 3DOR tridimensional OR
CRT OR three dimensional). The articles were selected
based on critical evaluation using the instruments (scores)
proposed by Jadad and Oxford. The references with great-
er degree of evidence were used. The recommendations
were elaborated from discussions held with a drafting
group composed of four members of the Brazilian Society
of Radiotherapy. The guideline was reviewed by an inde-
pendent group, which specializes in evidence-based clin-
ical guidelines. After completion, the guideline was re-
leased for public consultation for 15 days, and the
suggestions obtained were forwarded to the authors for
evaluation and possible insertion in the final text.
Introduction
Radiotherapy is an integral part of the multidisciplinary
treatment of lung cancer.
In small cell lung cancer, radiotherapy is performed
after chemotherapy (adjuvant) in tumors staged as exten-
sive disease,1 and concomitantly in tumors staged as local-
ized disease.2
In non-small cell lung cancer, radiotherapy is indicat-
ed before or after surgery (adjuvant), with the purpose of
making them surgically resectable or to prevent relapse
of locoregional disease and tumors with positive mar-
gins,3,4 while in unresectable tumors, it is preferably as-
sociated with chemotherapy.5
Radiation therapy has progressed in recent decades
due to advances in computerized systems that allow the
recognition of internal structures in the body. This rec-
ognition is done based on the patient’s imaging investiga-
tion, usually computed tomography. A more accurate
dose distribution that reaches the area intended to be
treated while sparing normal organs derives from the
information sent to the radiation device from a previ-
ously configured treatment planning system. This release