ASCO GUIDELINES Bundle

NSCLC Stage III

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7 Recommendation 5.3 ➤ Patients with stage III NSCLC who are not candidates for concurrent chemoradiation but are candidates for chemotherapy should be offered sequential chemotherapy and radiation therapy over radiation alone. (Strong recommendation; EB-B-H) Recommendation 5.4 ➤ Patients with stage III NSCLC receiving concurrent chemoradiation should be treated to 60 Gy. (Strong recommendation; EB-B-H) Recommendation 5.5 ➤ Doses higher than 60 Gy and up to 70 Gy may be considered for selected patients, with careful attention to doses to heart, lungs, and esophagus. (Strong recommendation; EB-B-L) Recommendation 5.6 ➤ Patients with stage III NSCLC receiving definitive radiation without chemotherapy in standard fractionation may be considered for radiation dose escalation and for modest hypofractionation from 2.15–4 Gy per fraction. (Weak recommendation; EB-B-L) Recommendation 5.7 ➤ Patients with stage III NSCLC receiving concurrent chemoradiation without disease progression during the initial therapy should be offered consolidation durvalumab for up to 12 months. (Strong recommendation; EB-B-H) Qualifying statement: There is insufficient evidence to alter the recommendation for consolidation durvalumab following concurrent chemo-radiation for molecularly defined subgroups (namely patients with an oncogenic driver alteration or those with low/no expression of programmed death-ligand 1 [PD- L1]).

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