Acute esophagitis and pneumonitis and late pulmonary, cardiac/great vessel, esophageal, brachial plexus and spinal toxicities are dose limiting for reRT. There are no data to guide the use of concurrent targeted therapy or immunotherapy with reRT, and this is not recommended outside of a clinical trial. The available data suggest potential benefit in clinical outcomes with concurrent chemoradiation for reRT, but the decision should be based on patient performance status, tolerance to prior systemic therapy and other individual patient/tumor characteristics. Composite dose constraints were also recommended. Of 236 articles, 49 remained after exclusions (3 prospective) and formed the basis for these recommendations on: 1) the role of concurrent chemotherapy with reRT, 2) factors associated with toxicity from reRT and 3) what reRT modalities, dose-fractionation schemas and dose rates should be used. Methods: A PRISMA systematic review assessed all studies published through 3/2019 evaluating toxicities, local control and/or overall survival for NSCLC thoracic reRT. Objectives: This ARS-ACR Appropriate Use Criteria Systematic Review and Guidelines on Reirradiation for NSCLC provides direct guidance on the safety and efficacy of reRT and recommends consensus dose constraints for thoracic reRT to minimize risks of high grade toxicities. To date, no systematic review on the safety and efficacy of reRT for NSCLC exists, and no dedicated guidelines are available. Thoracic reRT, however, is particularly challenging due to its considerable risk and the current lack of standardized approaches, guidelines and dose constraints. More recently, I have co-chaired the margins guidelines for breast conservation therapy (Society for Surgical Oncology SSO/ American Society of Clinical Oncology ASTRO) for invasive cancers and DCIS.Background: Reirradiation (reRT) for locoregional recurrences can provide durable control and improved symptoms and progression-free survival for select NSCLC patients. I have been on the board of directors of the National Accreditation Program for Breast Centers (NAPBC) of the American College of Surgeons for the last 5 years and have worked to develop national guidelines, standards and a surveying process for accreditation of breast centers, was on the editorial board for the Journal of Clinical Oncology and The Breast Journal for 3 years each, Associate Senior Breast Editor for International Journal of Radiation Therapy, Biology, Physics for 5 years, a member of the American College of Radiology Breast Appropriateness Criteria Committee to established clinical guidelines for breast cancer treatment, the NCCN Breast Panel and the American Board of Radiology Breast Panel for written and oral boards. In addition to being Chief of Breast Radiation Oncology across all of our Yale sites, I am the medical director of our department's facility at the Smilow Cancer Hospital Care Center in Waterford. The primary focus of my clinical research has been on clinical, pathological and molecular factors which may predict for outcomes in breast cancer patients treated with radiation therapy, ethnic variations in breast cancer, quality improvement, guidelines, and standards in breast health care delivery, and investigating radiation techniques.
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