ImportanceThe treatment of locally advanced non–small cell lung cancer (LA-NSCLC) has been informed by more than 5 decades of clinical trials and other relevant literature. However, controversies remain regarding the application of various radiation and systemic therapies in commonly encountered clinical scenarios.ObjectiveTo develop case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable LA-NSCLC.Evidence ReviewThe American Radium Society (ARS) Appropriate Use Criteria (AUC) Thoracic Committee guideline is an evidence-based consensus document assessing various clinical scenarios associated with LA-NSCLC. A systematic review of the literature with evidence ratings was conducted to inform the appropriateness of treatment recommendations by the ARS AUC Thoracic Committee for the management of unresectable LA-NSCLC.FindingsTreatment appropriateness of a variety of LA-NSCLC scenarios was assessed by a consensus-based modified Delphi approach using a range of 3 points to 9 points to denote consensus agreement. Committee recommendations were vetted by the ARS AUC Executive Committee and a 2-week public comment period before official approval and adoption. Standard of care management of good prognosis LA-NSCLC consists of combined concurrent radical (60-70 Gy) platinum-based chemoradiation followed by consolidation durvalumab immunotherapy (for patients without progression). Planning and delivery of locally advanced lung cancer radiotherapy usually should be performed using intensity-modulated radiotherapy techniques. A variety of palliative and radical fractionation schedules are available to treat patients with poor performance and/or pulmonary status. The salvage therapy for a local recurrence after successful primary management is complex and likely requires both multidisciplinary input and shared decision-making with the patient.Conclusions and RelevanceEvidence-based guidance on the management of various unresectable LA-NSCLC scenarios is provided by the ARS AUC to optimize multidisciplinary patient care for this challenging patient population.

中文翻译：

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美国镭协会针对不可切除的局部晚期非小细胞肺癌的适当使用标准

重要性 5 多年的临床试验和其他相关文献为局部晚期非小细胞肺癌 (LA-NSCLC) 的治疗提供了依据。然而，关于各种放射和全身治疗在常见临床情况中的应用仍然存在争议。目的制定病例参考共识和循证指南，为不可切除的 LA-NSCLC 的临床实践提供信息。证据审查美国镭协会 (ARS) 适当使用标准 (AUC) 胸科委员会指南是一份基于证据的共识文件，评估与 LA-NSCLC 相关的各种临床情况。对文献进行系统回顾并进行证据评级，以告知 ARS AUC 胸部委员会针对不可切除的 LA-NSCLC 治疗建议的适当性。结果通过基于共识的共识评估了各种 LA-NSCLC 情况的治疗适当性修改后的德尔菲法使用 3 分到 9 分的范围来表示共识。委员会的建议经过 ARS AUC 执行委员会的审查，并在正式批准和通过之前经过两周的公众评议期。良好预后 LA-NSCLC 的护理管理标准包括联合同步根治性 (60-70 Gy) 铂类放化疗，随后进行巩固 durvalumab 免疫治疗（适用于无进展的患者）。局部晚期肺癌放疗的计划和实施通常应使用调强放疗技术进行。有多种姑息性和根治性分割方案可用于治疗表现不佳和/或肺部状况不佳的患者。成功的初次治疗后局部复发的挽救治疗很复杂，可能需要多学科的投入和与患者共同决策。结论和相关性ARS AUC 提供了关于各种不可切除的 LA-NSCLC 病例管理的循证指南针对这一具有挑战性的患者群体，优化多学科患者护理。