Consensus Statement on Palliative Lung Radiotherapy: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control George Rodrigues, 1 Fergus Macbeth, 2 Bryan Burmeister, 3 Karie-Lynn Kelly, 4 Andrea Bezjak, 5 Corey Langer, 6 Carol Hahn, 7 Benjamin Movsas 8 Abstract The purpose of this work is to disseminate a consensus statement on palliative radiotherapy (RT) of lung cancer created in conjunction with the Third International Lung Cancer Consensus Workshop. The palliative lung RT workshop committee agreed on 5 questions relating to (1) patient selection, (2) thoracic external-beam radiation therapy (XRT) fractionation, (3) endobronchial brachytherapy (EBB), (4) concurrent chemotherapy (CC), and (5) palliative endpoint definitions. A PubMed search for primary/cross-referenced practice guidelines, consensus state- ments, meta-analyses, and/or systematic reviews was conducted. Final consensus statements were created after review and discussion of the available evidence. The following summary statements reflect the consensus of the international working group. 1. Key factors involved in the decision to deliver palliative RT include performance status, tumor stage, pulmonary function, XRT volume, symptomatology, weight loss, and patient preference. 2. Palliative thoracic XRT is generally indicated for patients with stage IV disease with current/impending symp- toms and for patients with stage III disease treated for palliative intent. 3. There is no evidence to routinely recommend EBB alone or in conjunction with other palliative maneuvers in the initial palliative management of endobronchial obstruction resulting from lung cancer. 4. There is currently no evidence to routinely recommend CC with palliative-intent RT. 5. Standard assessment of symptoms and health-related quality of life (QOL) using validated questionnaires should be carried out in palliative RT lung cancer trials. Despite an expanding literature, continued prospective randomized investigations to better define the role of XRT, EBB, and CC in the context of thoracic palliation of patients with lung cancer is needed. Clinical Lung Cancer, Vol. 13, No. 1, 1-5 © 2012 Elsevier Inc. All rights reserved. Keywords: Concurrent chemotherapy, Consensus statement, Endobronchial brachytherapy, External-beam radiation therapy, Lung cancer Introduction Palliative-intent thoracic radiotherapy (RT) has been used rou- tinely to relieve tumor-related symptoms such as chest pain, hemop- tysis, cough, shortness of breath, and bronchial obstruction. 1 The majority of randomized controlled trials and meta-analyses/system- atic reviews have focused on the areas of external-beam radiation therapy (XRT) dose fractionation, and the use of endobronchial brachytherapy (EBB) for thoracic palliation of lung cancer. The planned integration of concurrent chemotherapy (CC) with pallia- 1 Department of Radiation Oncology, University of Western Ontario, London, ON, Canada 2 National Institute for Health and Clinical Excellence, London, UK 3 Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Australia 4 Department of Radiation Oncology, Kootenai Cancer Center, Coeur d’Alene, ID 5 Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada 6 Department of Medicine, University of Pennsylvania, Philadelphia, PA 7 Duke Radiation Oncology, Raleigh, NC 8 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI Submitted: Feb 7, 2011; Revised: Apr 14, 2011; Accepted: Apr 26, 2011 Address for correspondence: George Rodrigues, MD, A3-808 London Regional Cancer, Program, 790 Commissioners Rd E, London, ON, Canada Fax: 519-685-8736; e-mail contact: george.rodrigues@lhsc.on.ca Review Clinical Lung Cancer January 2012 1 1525-7304/$ - see frontmatter © 2012 Elsevier Inc. All rights reserved. doi: 10.1016/j.cllc.2011.04.004