Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Oncology
  • Oncology Guidelines
  • Supportive care in...

Supportive care in lung cancer patients receiving concurrent chemotherapy and radiotherapy: ESTRO and ESMO Guideline

Written By : Hina Zahid |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-01-17T17:36:10+05:30  |  Updated On 17 Jan 2020 5:36 PM IST
Supportive care in lung cancer patients receiving concurrent chemotherapy and radiotherapy: ESTRO and ESMO Guideline
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

Concurrent chemotherapy and radiotherapy (CCRT) followed by durvalumab immune therapy in appropriate patients is considered to be the standard of care in most fit stage III non-small-cell lung cancer (NSCLC) patients. However, CCRT is a toxic treatment that affects all organ systems and may cause acute and permanent side effects, some of which may be lethal. Supportive care is therefore of utmost importance in this clinical setting.

A group of experts from the European Society for Therapeutic Radiology and Oncology (ESTRO) and the European Society of Medical Oncology (ESMO) identified the following items of importance for further improvement of supportive care: smoking cessation; nutrition before and during CCRT (including treatment and prevention of anorexia); physical exercise before and during CCRT; prevention and treatment of acute esophagitis and dysphagia; treatment of cough and dyspnea; treatment of skin reactions; treatment of fatigue; prophylaxis of nausea and emesis; prevention, diagnosis, and treatment of cardiac disease and damage; and optimization of radiotherapy techniques and chemotherapy adjustments to reduce toxicity in the era of immune therapy. The resulting recommendations are summarized in this manuscript and knowledge gaps identified, in which future investments are needed to improve supportive care and hence the quality of life and survival for our stage III NSCLC patients.

Following are the major recommendations:

Smoking cessation

Smoking cessation should actively be supported in all patients, also before the beginning of treatment as it may improve long-term survival, decrease side effects and risk of developing second primary cancers (level III, grade A).

Prevention and treatment of acute esophagitis and dysphagia

  • The administration of a proton pump inhibitor at a daily dose of 40 mg, from the beginning of radiotherapy up to 3 months after the end is recommended (level V, grade B).
  • Because esophageal candidosis frequently occurs, patients with grade 2 or more esophagitis may be given appropriate antifungal drugs (level V, grade B).
  • Symptomatic care, such as the administration of local anesthetics (e.g. lidocaine), systemic analgesics including opioids, is essential (level V, grade A).

Nutrition before and during CCRT, including treatment and prevention of anorexia

  • All patients should be offered assessment of nutritional risk and counselling by a trained professional before the start, during, and after concurrent chemoradiotherapy (level III, grade A).
  • Independent of the route of delivery, nutritional intake should cover at least 30 kcal and 1.0–1.5 g protein per kg body weight as well as the recommended daily allowance for all micronutrients (level III, grade A).
  • Enteral or parenteral feeding should be initiated promptly if oral intake is inadequate resulting in loss of ≥5% of body weight despite meticulous care and support (level III, grade A).

Physical exercise before and during CCRT

  • Resistance training improves and restores functional exercise capacity and should be offered to patients after concurrent chemoradiotherapy (level III, grade B).

Treatment of cough and dyspnea

  • The cause of cough and dyspnea should always be determined, and treatment should be initiated according to the etiology (level V, grade A)
  • The cause of cough and dyspnea should always be determined, and treatment should be initiated according to the etiology (level V, grade A).

Treatment of skin reactions

  • No preventive measures have to be taken to avoid skin toxicity (level V, grade A).
  • Dry desquamation may be treated with a moisturizing cream (level V, grade A).
  • Moist desquamation is treated as superficial burns (level V, grade A)

Treatment of fatigue

  • Only the short-term use of corticosteroids (dexamethasone: 4 mg twice a day for 14 days; methylprednisolone: 16 mg twice a day for 7 days) might be considered as pharmacological intervention to treat fatigue (level II, grade C).
  • Drugs other than corticosteroids, as well as dietary supplements have not convincingly shown a beneficial effect (level of evidence II, grade of recommendation B).
  • Moderate-intensity exercises such as walking, running, swimming, or cycling two to three times per week for 30–60 min if possible should be offered to the patients (level II, grade B).

Prophylaxis of nausea and vomiting

  • As chemotherapy is the most emetogenic part of concurrent chemotherapy and radiotherapy treatment, antiemetics should be given according to standard guidelines (level I, grade A).
  • Thoracic radiotherapy has a low emetogenic risk; prophylactic antiemetics are therefore generally not recommended on the days in which only radiotherapy is administered (level I, grade A).
  • Durvalumab has a low emetogenic potential (level I, grade A).

Prevention, diagnosis, and treatment of cardiac disease and damage

  • Patients should avoid cardiovascular risk factors such as smoking, being overweight, eating an unhealthy diet, and sedentary behavior (level V, grade A).
  • Radiotherapy techniques to decrease the dose to the heart as much as possible should be used (level II, grade A).
  • Cardiac disease should be diagnosed and treated as in non-irradiated patients (level V, grade A).

Radiotherapy techniques and chemotherapy adjustments to prevent toxicity in the era of immune therapy

  • Radiotherapy techniques, doses, and fractionation, as well as chemotherapy regimen, should be delivered according to international guidelines and similar to what has been used in randomized clinical trials for concurrent chemotherapy and radiotherapy with or without immunotherapy (level II, grade A).
  • The radiation dose to organs at risk, including all parts of the heart, should be kept as low as possible (level II, grade A)

For more details click on the link: https://doi.org/10.1016/j.annonc.2019.10.003

Source : Annals of Oncology
Hina Zahid
Hina Zahid

    Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    Aspirin Use in Male Smokers Aged 40-45 Years with Hypertension: Identifying the Ideal Candidates

    Aspirin Use in Male Smokers Aged 40-45 Years with Hypertension: Identifying the Ideal Candidates

    National Consensus 2025 on Role of Bisoprolol Across CV Continuum in Women: Top 10 Takeaways

    National Consensus 2025 on Role of Bisoprolol Across CV Continuum in Women: Top 10 Takeaways

    Relevance of Pioglitazone in Indian T2DM Care Continuum

    Relevance of Pioglitazone in Indian T2DM Care Continuum

    Azmarda Outperforms Generic Sacubitril/Valsartan in HFrEF Management, says new study

    Azmarda Outperforms Generic Sacubitril/Valsartan in HFrEF Management, says new study

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    View All

    Journal Club Today

    Global Omega-3 Shortage Poses Serious Health and Environmental Risks: Study

    Global Omega-3 Shortage Poses Serious Health and Environmental Risks: Study

    View All

    Health News Today

    Health Bulletin 31/May/2025

    Health Bulletin 31/May/2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok