Clinical Practice Statements

  • Clinical practice statements provide physicians with evidence-based guidance to help ensure that patients receive the best possible care. They are built from the body of established literature complemented by expert opinion.

    Completed guidelines are published in one of ASTRO's three journals: International Journal of Radiation Oncology*Biology*Physics, Practical Radiation Oncology, and Advances in Radiation Oncology.

  • Radiation therapy for glioblastoma: An ASTRO evidence-based guideline (online publication March 2016, print publication July 2016)

    Guideline panel: Alvin Cabrera, MD, John Kirkpatrick, MD, John Fiveash, MD, Helen Shih, MD, Eugene Koay, MD, Stephen Lutz, MD, Joshua Petit, MD, Samuel Chao, MD, Paul Brown, MD, Michael Vogelbaum, MD, PhD, David Reardon, MD, Arnab Chakravarti, MD,  Patrick Wen, MD, Eric Chang, MD

    This guideline will discuss the role of radiotherapy in both primary and recurrent settings, taking into account both disease and patient factors, including performance status and age.

    Read the executive summary
    Read the full guideline


    Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (online publication January 2012, print publication July 2012)

    Authors: May N. Tsao, MD, Dirk Rades, MD, Andrew Wirth, MD, Simon S. Lo, MD, Brita L. Danielson, MD, Laurie E. Gaspar, MD, MBA, Paul W. Sperduto, MD, MPP,Michael A. Vogelbaum, MD, PhD, Jeffrey D. Radawski, MD, Jian Z. Wang, PhD, Michael T. Gillin, PhD, Najeeb Mohideen, MD, Carol A. Hahn, MD, and Eric L. Chang, MD

    This guideline systematically reviews the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases.

    Read the guideline

    Evidence-based guideline on whole breast irradiation (in progress-anticipated publication in 2017/2018)

    Authors: Reshma Jagsi, MD, PhD, Benjamin Smith, MD, Jennifer Bellon, MD, Rachel Blitzblau, MD, PhD, Bruce Haffty, MD, Carol Hahn, MD, Francine Halberg, MD, Karen Hoffman, MD, Kathleen Horst, MD, Jean Moran, PhD, Tim Whelan, BM, BCh, Jean Wright, MD

    The proposed guideline will update the guideline originally published in 2011 in light of the considerable new evidence that has accumulated in the intervening years and also allow for a more comprehensive statement regarding techniques of whole breast irradiation, beyond the issue of fractionation alone.

    This guideline is currently under development.

    Once complete, this guideline will replace the original ASTRO guideline on fractionation for WBI.


    Accelerated partial breast irradiation: Update of an ASTRO evidence-based consensus statement (online publication September 2016, print publication March 2017)

    Authors: Candace Correa, MD, Eleanor E. Harris, MD, Maria Cristina Leonardi, MD, Benjamin D. Smith, MD, Alphonse G. Taghian, MD, PhD, Alastair M. Thompson, MD, Julia White, MD, Jay R. Harris, MD

    This update discusses new literature since the original consensus statement was published in 2009, revises the "suitable," "cautionary," and "unsuitable" patient groups for APBI, and provides guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer. 

    Read the executive summary
    Read the full consensus statement

    This document updates the original ASTRO consensus statement on APBI.


    Postmastectomy radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update (online publication September 2016, print publication November 2016)

    Authors: Abram Recht, Elizabeth A. Comen, Richard E. Fine, Gini F. Fleming, Patricia H. Hardenbergh, Alice Y. Ho, Clifford A. Hudis, E. Shelley Hwang, Jeffrey J. Kirshner, Monica Morrow, Kilian E. Salerno, George W. Sledge, Jr, Lawrence J. Solin, Patricia A. Spears, Timothy J. Whelan, Mark R. Somerfield, Stephen B. Edge

    This update to the ASCO guideline on use of postmastectomy radiotherapy (PMRT) focused on key areas of ongoing controversy, including the use of PMRT for patient with one to three positive lymph nodes or who are undergoing neoadjuvant systemic therapy; selected technical aspects of PMRT, particularly the extent of regional nodal irradiation; and whether PMRT is indicated in women with T1-2 tumors and a positive sentinel node biopsy who do not undergo completion axillary lymph node dissection.

    Read the guideline


    Society of Surgical Oncology - American Society for Radiation Oncology - American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ (online publication June 2016, print publication September 2016)

    Authors: Monica Morrow, MD, Kimberly J. Van Zee, MD, Lawrence J. Solin, MD, Nehmat Houssami, MBBS, PhD, Mariana Chavez-MacGregor, MD, Jay R. Harris, MD, Janet Horton, MD, Shelley Hwang, MD, Peggy L. Johnson, M. Luke Marinovich, PhD, Stuart J. Schnitt, MD, Irene Wapnir, MD, Meena S. Moran, MD

    A multidisciplinary consensus panel developed recommendations on optimal negative margin width for ducatal carcinoma in situ treated with breast-conserving surgery and whole-breast irradiation based on a meta-analysis of margin width and ipsilateral breast tumor recurrence, as well as other published literature.

    Read the guideline


    Society of Surgical Oncology - American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive beast cancer (print publication March 2014)

    Authors: Meena S. Moran, MD, Stuart J. Schnitt, MD, Armando E. Giuliano, MD, Jay R. Harris, MD, Seema A. Khan, MD, Janet Horton, MD, Suzanne Klimberg, MD, Mariana Chavez-MacGregor, MD, Gary Freedman, MD, Nehmat Houssami, MD, PhD, Peggy L. Johnson, and Monica Morrow, MD

    This guideline examines the relationship between margin width and ipsilateral breast tumor recurrence and offers recommendations for defining appropriate margins in the setting of breast conserving surgery and adjuvant radiation therapy.

    Read the guideline


    Fractionation for whole breast irradiation: An American Society for Radiation Oncology (ASTRO) evidence-based guideline (online publication July 2010, print publication September 2011)

    Authors: Benjamin D. Smith, MD, Søren M. Bentzen, PhD, DSc, Candace R. Correa, MD, Carol A. Hahn, MD, Patricia H. Hardenbergh, MD, Geoffrey S. Ibbott, PhD, Beryl McCormick, MD, FACR, Julie R. McQueen, CHES, RHEd, Lori J. Pierce, MD, Simon N. Powell, MD, PhD, Abram Recht, MD, Alphonse G. Taghian, MD, PhD, Frank A. Vicini, MD, FACR, Julia R. White, MD, and Bruce G. Haffty, MD

    This guideline discusses the appropriate use of hypofractionated whole breast irradiation (HF-WBI) as adjuvant treatment of breast cancer following breast-conserving surgery.

    Read the guideline

    ASTRO is currently developing a new guideline on WBI, which will replace this one once it is complete. 


    Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO) (print publication July 2009)

    Authors: Benjamin D. Smith, MD, Douglas W. Arthur, MD, Thomas A. Buchholz, MD, Bruce G. Haffty, MD, Carol A. Hahn, MD, Patricia H. Hardenbergh, MD, Thomas B. Julian, MD, Lawrence B. Marks, MD, Dorin A. Todor, PhD, Frank A. Vicini, MD, Timothy J. Whelan, MD, Julia White, MD, Jennifer Y. Wo, MD, and Jay R. Harris, MD

    This consensus statement provides guidance for patients and physicians regarding the use of accelerated partial breast irradiation (APBI), based on current published evidence complemented by expert opinion.

    Read the consensus statement

    ASTRO has published a partial update of this guideline. Read the Executive Summary and the full update.

    Evidence-based guideline with ASCO and AUA on hypofractionated radiation for localized prostate cancer (in progress-anticipated publication in 2018)

    Authors: Scott C. Morgan, MD, MSc, Daniel Barocas, MD, MPH, Soren Bentzen, PhD, DMSc, Mark Buyyounouski, MD, MS, Michael Chang, MD, Jason Efstathiou, MD, Per Halvorsen, PhD, Karen Hoffman, MD, Bridget Koontz, MD, Colleen Lawton MD, C. Mark Leyrer, MD, Daniel Lin, MD, D. Andrew Loblaw, MD, MSc, Michael Ray, MD, Howard Sandler, MD, MS

    This guideline will address both moderately hypofractionated (2.4-3.4 Gy per fraction) and ultra hypofractionated (5 Gy or more per fraction) external beam regimens and how they compare to conventional fractionation when delivered to the intact prostate. It will also discuss technical issues, including normal tissue dose constraints, treatment volumes, and use of image-guided and intensity-modulated radiotherapy.

    This guideline is currently under development.


    Adjuvant and Salvage Radiation Therapy After Prostatectomy: American Society for Radiation Oncology/American Urological Association Guidelines (print publication August 2013)

    Authors: Richard K. Valicenti, MD, MBA, Ian Thompson Jr., MD, Peter Albertsen, MD, MS, Brian J. Davis, MD, PhD, S. Larry Goldenberg, MD, J. Stuart Wolf, MD, Oliver Sartor, MD, Eric Klein, MD, Carol Hahn, MD, Jeff Michalski, MD, MBA, Mack Roach III, MD, and Martha M Faraday, PhD

    This guideline provides direction to clinicians and patients regarding the use of radiotherapy after prostatectomy in patients with and without evidence of prostate cancer recurrence.

    Read the executive summary

    Appropriate customization of radiation therapy for stage II and III rectal cancer: An ASTRO clinical practice statement using the RAND/UCLA appropriateness method (online publication November 2015, print publication May 2016)

    Authors: Karyn A. Goodman, M.D., M.S., Caroline E. Patton, M.A., George A. Fisher, M.D., Ph.D., Sarah E. Hoffe, M.D., Michael G. Haddock, M.D., Parag J. Parikh, M.D., John Kim, M.D., Nancy Baxter, M.D., Ph.D., Brian G. Czito, M.D., Theodore S. Hong, M.D., Joseph M. Herman, M.D., M.S., Christopher H. Crane, M.D., Karen E. Hoffman, M.D.

    This clinical practice statement addresses appropriate customization of neoadjuvant and adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection.

    Read the executive summary
    Read the full clinical practice statement 

    An analysis of appropriate delivery of postoperative radiation therapy for endometrial cancer using the RAND/UCLA Appropriateness Method (online publication January 2016)

    Authors: Ellen Jones, MD, PhD, Sushil Beriwal, MD, David Beyer, MD, Junzo Chino, MD, Anuja Jhingran, MD, Larissa Lee, MD, Jeff Michalski, MD, MBA, Arno J. Mundt, MD, Caroline Patton, MA, Ivy Petersen, MD, Lorraine Portelance, MD, Julie K. Schwarz, MD, PhD, Susan McCloskey, MD, MSHS 

    This paper summarizes the results of ASTRO’s analysis of appropriate delivery of postoperative radiation therapy (RT) for endometrial cancer using the RAND/University of California, Los Angeles (UCLA) Appropriateness Method.

    Read the executive summary
    Read the full analysis


    The role of post-operative radiation therapy for endometrial cancer: An ASTRO evidence-based guideline (online publication March 2014, print publication May 2014)

    Authors: Ann Klopp, MD, PhD, Benjamin Smith, MD, Kaled Alektiar, MD, Alvin Cabrera, MD, Antonio Damato, PhD, Beth Erickson, MD, Gini Fleming, MD, David Gaffney, MD, PhD, Kathryn Greven, MD, Karen Lu, MD, David Miller, MD, David Moore, MD, Daniel Petereit, MD, Tracey Schefter, MD, William Small Jr., MD, Catheryn Yashar, MD, Akila N. Viswanathan, MD, MPH

    This guideline presents evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer.

    Read the executive summary
    Read the full guideline

    Radiation therapy for oropharyngeal squamous cell carcinoma: An ASTRO evidence-based guideline (online publication April 2017, print publication July 2017)

    Authors: David Sher, MD, Avraham Eisbruch, MD, David Brizel, MD, Louis Harrison, MD, Roy Tischler, MD, Andy Trotti, MD, John Waldron, MD, Benjamin Moeller, MD, Gopal Bajaj, MD, Aditya Hathore, MD, David Adelstein, MD, Ezra Cohen, MD, James Rocco, MD, PhD, Erich Sturgis, MD, Charles Lu, MD, Harry Quon, MD

    This guideline will focus on four critical topics facing radiation oncologists treating oropharyngeal cancer: the integration of concurrent chemotherapy with radiotherapy in the definitive and adjuvant settings, the indications for induction chemotherapy and the appropriate dose and fractionation regimens for treating the disease.

    Read the executive summary
    Read the full guideline

    Updated evidence-based guideline on palliative thoracic radiotherapy in lung cancer (in progress-publication anticipated in 2017)

    Authors: Benjamin Moeller, MD, PhD, Ehsan Balagamwala, MD, Aileen Chen, MD, Giuseppe Giaccone, MD, PhD, Matthew Koshy, MD, Kimberly M. Creach, MD, Sandra Zaky, MD, MS, George Rodrigues, MD, PhD

    This guideline will update the recommendation on the use of concurrent chemotherapy in combination with palliative EBRT for patients with locally-advanced and advanced NSCLC based on new level 1 evidence published since the original guideline.

    This guideline update is currently under development.

    Once complete, this document will partially update the original ASTRO palliative thoracic guideline.

     


    Palliative radiation therapy for bone metastases: Update of an ASTRO evidence-based guideline (online publication August 2016, print publication January 2017)

    Authors: Stephen Lutz, MD, Tracy Balboni, MD, MPH, Joshua Jones, MD, Simon Lo, MB, ChB, Joshua Petit, MD, Shayna E. Rich, MD, PhD, Rebecca Wong, MB, ChB, Carol Hahn, MD

    This guideline update covers all eight questions from the original guideline published in 2011. It discusses new high-quality literature, as well as implications for practice. 

    Read the guideline update

    This document updates the original ASTRO bone metastases guideline. Read the original Executive Summary and the original full guideline.


    Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (online publication January 2012, print publication July 2012)

    Authors: May N. Tsao, MD, Dirk Rades, MD, Andrew Wirth, MD, Simon S. Lo, MD, Brita L. Danielson, MD, Laurie E. Gaspar, MD, MBA, Paul W. Sperduto, MD, MPP, Michael A. Vogelbaum, MD, PhD, Jeffrey D. Radawski, MD, Jian Z. Wang, PhD, Michael T. Gillin, PhD, Najeeb Mohideen, MD, Carol A. Hahn, MD, and Eric L. Chang, MD

    This guideline systematically reviews the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases.

    Read the guideline


    Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline (online and print publication April 2011)

    Authors: George Rodrigues, MD, MSc, Gregory M.M. Videtic, MD, CM, FRCPC, Ranjan Sur, MD, PhD, Andrea Bezjak, MD, FRCPC, Jeffrey Bradley, MD, Carol A. Hahn, MD, Corey Langer, MD, Keith L. Miller, MD, Benjamin J. Moeller, MD, PhD, Kenneth Rosenzweig, MD, and Benjamin Movsas, MD

    This guideline provides guidance on the use of external beam radiotherapy, endobronchial brachytherapy and concurrent chemotherapy in the setting of palliative thoracic treatment of lung cancer based on available evidence complemented by expert opinion.

    Read the guideline

    ASTRO is currently developing a partial update of this guideline.


    Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline (online publication January 2011, print publication March 2011)

    Authors: Stephen Lutz, MD, Lawrence Berk, MD, PhD, Eric Chang, MD, Edward Chow, MBBS, Carol Hahn, MD, Peter Hoskin, MD, David Howell, MD, Andre Konski, MD, Lisa Kachnic, MD, Simon Lo, MB, ChB, Arjun Sahgal, MD, Larry Silverman, MD, Charles von Gunten, MD, PhD, FACP, Ehud Mendel, MD, FACS, Andrew Vassil, MD, Deborah Watkins Bruner, RN, PhD, and William Hartsell, MD

    This guideline addresses appropriate use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion.

    Read the executive summary
    Read the full guideline

    ASTRO has published an update of this guideline.

    Updated evidence-based guideline on palliative thoracic radiotherapy in lung cancer (in progress-anticipated publication in 2017)

    Authors: Benjamin Moeller, MD, PhD, Ehsan Balagamwala, MD, Aileen Chen, MD, Giuseppe Giaccone, MD, PhD, Matthew Koshy, MD, Kimberly M. Creach, MD, Sandra Zaky, MD, MS, George Rodrigues, MD, PhD

    This guideline will update the recommendation on the use of concurrent chemotherapy in combination with palliative EBRT for patients with locally-advanced and advanced NSCLC based on new level 1 evidence published since the original guideline.

    This guideline update is currently under development.
    Once complete, this document will partially update the original ASTRO palliative thoracic guideline.


    Stereotactic body radiotherapy for early stage non-small cell lung cancer: An ASTRO evidence-based clinical practice guideline (in progress-anticipated publication in 2017)

    Authors: Gregory Videtic, MD, Jessica Doningham, MD, Meredith Giuliani, MD, John Heinzerling, MD, Tomer Karras, MD, Christopher Kelsey, MD, Brian Lally, MD, Simon Lo, MD, Drew Moghanaki, MD, Benjamin Movsas, MD, Andrea Rimner, MD, PhD, Michael Roach, MD, George Rodrigues, MD, Shervin Shirvani, MD, Charles Simone, MS, Robert Timmerman, MD, Megan Daly, MD

    This guideline will explore the appropriateness of SBRT based on various patient and tumor characteristics and offer recommendations on how to tailor SBRT to provide adequate dose for high risk tumors. It will also discuss the role of SBRT as salvage therapy after recurrence.

    This guideline is currently under development.


    Definitive and adjuvant radiotherapy in locally advanced non-small cell lung cancer: An American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline (online publication May 2015, print publication June 2015)

    Authors: George Rodrigues, MD, PhD, FRCPC, Hak Choy, MD, Jeffrey Bradley, MD, Kenneth Rosenzweig, MD, Jeffrey Bogart, MD, Walter Curran, MD, Elizabeth Gore, MD, Corey Langer, MD, Alexander Louie, MD, Stephen Lutz, MD, Mitchell Machtay, MD, Varun Puri, MD, Maria Werner-Wasik, MD, Gregory M.M. Videtic MD, CM, FRCPC.

    This guideline offers guidance to physicians and patients with regard to the use of external beam radiation therapy in locally advanced non-small cell lung cancer, both as primary curative therapy and when given with chemotherapy or surgery.

    Read the executive summary for definitive radiotherapy
    Read the executive summary for adjuvant radiotherapy
    Read the full guideline  


    Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline (2011)

    Authors: George Rodrigues, MD, MSc, Gregory M.M. Videtic, MD, CM, FRCPC, Ranjan Sur, MD, PhD, Andrea Bezjak, MD, FRCPC, Jeffrey Bradley, MD, Carol A. Hahn, MD, Corey Langer, MD, Keith L. Miller, MD, Benjamin J. Moeller, MD, PhD, Kenneth Rosenzweig, MD, and Benjamin Movsas, MD

    This guideline provides guidance on the use of external beam radiotherapy, endobronchial brachytherapy and concurrent chemotherapy in the setting of palliative thoracic treatment of lung cancer based on available evidence complemented by expert opinion.

    Read the guideline

    ASTRO is currently developing a partial update of this guideline.

  • These clinical practice statements are current and have been published in one of ASTRO's journals.


    Radiation therapy for oropharyngeal squamous cell carcinoma: An ASTRO evidence-based guideline (online publication April 2017, print publication July 2017

    Authors: David Sher, MD, Avraham Eisbruch, MD, David Brizel, MD, Louis Harrison, MD, Roy Tischler, MD, Andy Trotti, MD, John Waldron, MD, Benjamin Moeller, MD, Gopal Bajaj, MD, Aditya Hathore, MD, David Adelstein, MD, Ezra Cohen, MD, James Rocco, MD, PhD, Erich Sturgis, MD, Charles Lu, MD, Harry Quon, MD

    This guideline will focus on four critical topics facing radiation oncologists treating oropharyngeal cancer: the integration of concurrent chemotherapy with radiotherapy in the definitive and adjuvant settings, the indications for induction chemotherapy and the appropriate dose and fractionation regimens for treating the disease.

    Read the executive summary
    Read the full guideline


    Accelerated partial breast irradiation: Update of an ASTRO evidence-based consensus statement (online publication September 2016, print publication March 2017)

    Authors: Candace Correa, MD, Eleanor E. Harris, MD, Maria Cristina Leonardi, MD, Benjamin D. Smith, MD, Alphonse G. Taghian, MD, PhD, Alastair M. Thompson, MD, Julia White, MD, Jay R. Harris, MD

    This update discusses new literature since the original consensus statement was published in 2009, revises the "suitable," "cautionary," and "unsuitable" patient groups for APBI, and provides guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer. 

    Read the executive summary
    Read the full guideline

    This document updates the original ASTRO consensus statement on APBI.


    Palliative radiation therapy for bone metastases: Update of an ASTRO evidence-based guideline (online publication August 2016, print publication January 2017)

    Authors: Stephen Lutz, MD, Tracy Balboni, MD, MPH, Joshua Jones, MD, Simon LO, MB, ChB, Joshua Petit, MD, Shayna E. Rich, MD, PhD, Rebecca Wong, MB, ChB, Carol Hahn, MD

    This guideline update covers all eight questions from the original guideline published in 2011. It discusses new high-quality literature, as well as implications for practice. 

    Read the guideline update

    This document updates the original ASTRO bone metastases guideline. Read the original Executive Summary and the original full guideline.


    Postmastectomy radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update (online publication September 2016, print publication November 2016)

    Authors: Abram Recht, Elizabeth A. Comen, Richard E. Fine, Gini F. Fleming, Patricia H. Hardenbergh, Alice Y. Ho, Clifford A. Hudis, E. Shelley Hwang, Jeffrey J. Kirshner, Monica Morrow, Kilian E. Salerno, George W. Sledge Jr, Lawrence J. Solin, Patricia A. Spears, Timothy J. Whelan, Mark R. Somerfield, Stephen B. Edge

    This update to the ASCO guideline on use of postmastectomy radiotherapy (PMRT) focused on key areas of ongoing controversy, including the use of PMRT for patient with one to three positive lymph nodes or who are undergoing neoadjuvant systemic therapy; selected technical aspects of PMRT, particularly the extent of regional nodal irradiation; and whether PMRT is indicated in women with T1-2 tumors and a positive sentinel node biopsy who do not undergo completion axillary lymph node dissection.

    Read the guideline


    Society of Surgical Oncology-American Society for Radiation Oncology - American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ (online publication June 2016, print publication September 2016)

    Authors: Monica Morrow, MD, Kimberly J. Van Zee, MD, Lawrence J. Solin, MD, Nehmat Houssami, MBBS, PhD, Mariana Chavez-MacGregor, MD, Jay R. Harris, MD, Janet Horton, MD, Shelley Hwang, MD, Peggy L. Johnson, M. Luke Marinovich, PhD, Stuart J. Schnitt, MD, Irene Wapnir, MD, Meena S. Moran, MD

    A multidisciplinary consensus panel developed recommendations on optimal negative margin width for ducatal carcinoma in situ treated with breast-conserving surgery and whole-breast irradiation based on a meta-analysis of margin width and ipsilateral breast tumor recurrence, as well as other published literature.

    Read the guideline


    Radiation therapy for glioblastoma: An ASTRO evidence-based guideline (online publication March 2016, print publication June 2016)

    Authors: Alvin Cabrera, MD, John Kirkpatrick, MD, John Fiveash, MD, Helen Shih, MD, Eugene Koay, MD, Stephen Lutz, MD, Joshua Petit, MD, Samuel Chao, MD, Paul Brown, MD, Michael Vogelbaum, MD, PhD, David Reardon, MD, Arnab Chakravarti, MD, Patrick Wen, MD, Eric Chang, MD

    This guideline discusses the role of radiotherapy in both primary and recurrent settings, taking into account both disease and patient factors, including performance status and age.

    Read the executive summary
    Read the full guideline 


    Appropriate customization of radiation therapy for stage II and III rectal cancer: An ASTRO clinical practice statement using the RAND/UCLA Appropriateness Method (online publication November 2015, print publication May 2016)

    Authors: Karyn A. Goodman, MD, MS, Caroline E. Patton, MA, George A. Fisher, MD, PhD, Sarah E. Hoffe, MD, Michael G. Haddock, MD, Parag J. Parikh, MD, John Kim, MD, Nancy Baxter, MD, PhD, Brian G. Czito, MD, Theodore S. Hong, MD, Joseph M. Herman, MD, MS, Christopher H. Crane, MD, Karen E. Hoffman, MD

    This clinical practice statement addresses appropriate customization of neoadjuvant and adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection.

    Read the executive summary
    Read the full clinical practice statement 


    An analysis of appropriate delivery of postoperative radiation therapy for endometrial cancer using the RAND/UCLA Appropriateness Method (online publication January 2016)

    Authors: Ellen Jones, MD, PhD, Sushil Beriwal, MD, David Beyer, MD, Junzo Chino, MD, Anuja Jhingran, MD, Larissa Lee, MD, Jeff Michalski, MD, MBA, Arno J. Mundt, MD, Caroline Patton, MA, Ivy Petersen, MD, Lorraine Portelance, MD, Julie K. Schwarz, MD, PhD, Susan McCloskey, MD, MSHS

    This paper summarizes the results of ASTRO’s analysis of appropriate delivery of postoperative radiation therapy (RT) for endometrial cancer using the RAND/University of California, Los Angeles (UCLA) Appropriateness Method.

    Read the executive summary
    Read the full analysis


    Definitive and adjuvant radiotherapy in locally advanced non-small cell lung cancer: An American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline (online publication May 2015, print publication June 2015)

    Authors: George Rodrigues, MD, PhD, FRCPC, Hak Choy, MD, Jeffrey Bradley, MD, Kenneth Rosenzweig, MD, Jeffrey Bogart, MD, Walter Curran, MD, Elizabeth Gore, MD, Corey Langer, MD, Alexander Louie, MD, Stephen Lutz, MD, Mitchell Machtay, MD, Varun Puri, MD, Maria Werner-Wasik, MD, Gregory M.M. Videtic, MD, CM, FRCPC

    This guideline provides guidance to physicians and patients with regard to the use of external beam radiation therapy in locally advanced non-small cell lung cancer, both as primary curative therapy and when given with chemotherapy or surgery.

    Read the executive summary for definitive radiotherapy
    Read the executive summary for adjuvant radiotherapy
    Read the full guideline


    The role of post-operative radiation therapy for endometrial cancer: An ASTRO evidence-based guideline (online publication March 2014, print publication May 2014)

    Authors: Ann Klopp, MD, PhD, Benjamin Smith, MD, Kaled Alektiar, MD, Alvin Cabrera, MD, Antonio Damato, PhD, Beth Erickson, MD, Gini Fleming, MD, David Gaffney, MD, PhD, Kathryn Greven, MD, Karen Lu, MD, David Miller, MD, David Moore, MD, Daniel Petereit, MD, Tracey Schefter, MD, William Small Jr., MD, Catheryn Yashar, MD, Akila N. Viswanathan, MD, MPH

    This guideline presents evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer.

    Read the executive summary
    Read the full guideline


    Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer (print publication March 2014)

    Authors: Meena S. Moran, MD, Stuart J. Schnitt, MD, Armando E. Giuliano, MD, Jay R. Harris, MD, Seema A. Khan, MD, Janet Horton, MD, Suzanne Klimberg, MD, Mariana Chavez-MacGregor, MD, Gary Freedman, MD, Nehmat Houssami, MD, PhD, Peggy L. Johnson, and Monica Morrow, MD

    This guideline examines the relationship between margin width and ipsilateral breast tumor recurrence and offers recommendations for defining appropriate margins in the setting of breast conserving surgery and adjuvant radiation therapy.

    Read the guideline


    Adjuvant and salvage radiation therapy after prostatectomy: American Society for Radiation Oncology/American Urological Association Guideline (print publication August 2013)

    Authors: Richard K. Valicenti, MD, MBA, Ian Thompson Jr., MD, Peter Albertsen, MD, MS, Brian J. Davis, MD, PhD, S. Larry Goldenberg, MD, J. Stuart Wolf, MD, Oliver Sartor, MD, Eric Klein, MD, Carol Hahn, MD, Jeff Michalski, MD, MBA, Mack Roach III, MD, and Martha M. Faraday, PhD

    This guideline provides direction to clinicians and patients regarding the use of radiotherapy after prostatectomy in patients with and without evidence of prostate cancer recurrence.

    Read the executive summary


    Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (online publication January 2012, print publication July 2012)

    Authors: May N. Tsao, MD, Dirk Rades, MD, Andrew Wirth, MD, Simon S. Lo, MD, Brita L.Danielson, MD, Laurie E. Gaspar, MD, MBA, Paul W. Sperduto, MD, MPP, Michael A.Vogelbaum, MD, PhD, Jeffrey D. Radawski, MD, Jian Z. Wang, PhD, Michael T. Gillin, PhD, Najeeb Mohideen, MD, Carol A. Hahn, MD, and Eric L. Chang, MD

    This guideline systematically reviews the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases.

    Read the guideline


    Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline (online and print publication April 2011)

    Authors: George Rodrigues, MD, MSc, Gregory M.M. Videtic, MD, CM, FRCPC, Ranjan Sur, MD, PhD, Andrea Bezjak, MD, FRCPC, Jeffrey Bradley, MD, Carol A. Hahn, MD, Corey Langer, MD, Keith L. Miller, MD, Benjamin J. Moeller, MD, PhD, Kenneth Rosenzweig, MD, and Benjamin Movsas, MD

    This guideline offers guidance on the use of external beam radiotherapy, endobronchial brachytherapy and concurrent chemotherapy in the setting of palliative thoracic treatment of lung cancer.

    Read the guideline

    ASTRO is currently developing a partial update of this guideline.


    Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline (online publication January 2011, print publication March 2011)

    Authors: Stephen Lutz, MD, Lawrence Berk, MD, PhD, Eric Chang, MD, Edward Chow, MBBS, Carol Hahn, MD, Peter Hoskin, MD, David Howell, MD, Andre Konski, MD, Lisa Kachnic, MD, Simon Lo, MB, ChB, Arjun Sahgal, MD, Larry Silverman, MD, Charles von Gunten, MD, PhD, FACP, Ehud Mendel, MD, FACS, Andrew Vassil, MD, Deborah Watkins Bruner, RN, PhD, and William Hartsell, MD

    This guideline addresses appropriate use of radiotherapy in the treatment of bone metastases according to current published evidence complemented by expert opinion.

    Read the executive summary
    Read the full guideline

    ASTRO has published an update of this guideline.


    Fractionation for whole breast irradiation: An American Society for Radiation Oncology (ASTRO) evidence-based guideline (online publication July 2010, print publication September 2011)

    Authors: Benjamin D. Smith, MD, Søren M. Bentzen, PhD, DSc, Candace R. Correa, MD, Carol A. Hahn, MD, Patricia H. Hardenbergh, MD, Geoffrey S. Ibbott, PhD, Beryl McCormick, MD, FACR, Julie R. McQueen, CHES, RHEd, Lori J. Pierce, MD, Simon N. Powell, MD, PhD, Abram Recht, MD, Alphonse G. Taghian, MD, PhD, Frank A. Vicini, MD, FACR, Julia R. White, MD, and Bruce G. Haffty, MD

    This guideline discusses appropriate use of hypofractionated whole breast irradiation (HF-WBI) as adjuvant treatment of breast cancer following breast-conserving surgery.

    Read the guideline

    ASTRO is currently developing a new guideline on WBI, which will replace this one once it is complete.


    Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO) (print publication July 2009)

    Authors: Benjamin D. Smith, MD, Douglas W. Arthur, MD, Thomas A. Buchholz, MD, Bruce G. Haffty, MD, Carol A. Hahn, MD, Patricia H. Hardenbergh, MD, Thomas B. Julian, MD, Lawrence B. Marks, MD, Dorin A. Todor, PhD, Frank A. Vicini, MD, Timothy J. Whelan, MD, Julia White, MD, Jennifer Y. Wo, MD, and Jay R. Harris, MD

    This consensus statement provides guidance for patients and physicians regarding the use of accelerated partial breast irradiation (APBI), based on current published evidence complemented by expert opinion.

    Read the consensus statement

    ASTRO has published a partial update of this guideline. Read the Executive Summary and the full update.

    These clinical practice statements are currently under development and are not yet published.


    Evidence-based guideline with ASCO and AUA on hypofractionated radiation for localized prostate cancer (publication anticipated in 2018)

    Authors: Scott C. Morgan, MD, MSc, Daniel Barocas, MD, MPH, Soren Bentzen, PhD, DMSc, Mark Buyyounouski, MD, MS, Michael Chang, MD, Jason Efstathiou, MD, Per Halvorsen, PhD, Karen Hoffman, MD, Bridget Koontz, MD, Colleen Lawton MD, C. Mark Leyrer, MD, Daniel Lin, MD, D. Andrew Loblaw, MD, MSc, Michael Ray, MD, Howard Sandler, MD, MS

    This guideline will address both moderately hypofractionated (2.4-3.4 Gy per fraction) and ultra hypofractionated (5 Gy or more per fraction) external beam regimens and how they compare to conventional fractionation when delivered to the intact prostate. It will also discuss technical issues, including normal tissue dose constraints, treatment volumes, and use of image-guided and intensity-modulated radiotherapy.


    Evidence-based guideline on whole breast irradiation (publication anticipated in 2017/2018)

    Authors: Reshma Jagsi, MD, PhD, Benjamin Smith, MD, Jennifer Bellon, MD, Rachel Blitzblau, MD, PhD, Bruce Haffty, MD, Carol Hahn, MD, Francine Halberg, MD, Karen Hoffman, MD, Kathleen Horst, MD, Jean Moran, PhD, Tim Whelan, BM, BCh, Jean Wright, MD

    The proposed guideline will update the guideline originally published in 2011 in light of the considerable new evidence that has accumulated in the intervening years and also allow for a more comprehensive statement regarding techniques of whole breast irradiation, beyond the issue of fractionation alone.

    Once complete, this guideline will replace the original ASTRO guideline on fractionation for WBI.


    Updated evidence-based guideline on palliative thoracic radiotherapy in lung cancer (publication anticipated in 2017)

    Authors: Benjamin Moeller, MD, PhD, Ehsan Balagamwala, MD, Aileen Chen, MD, Giuseppe Giaccone, MD, PhD, Matthew Koshy, MD, Kimberly M. Creach, MD, Sandra Zaky, MD, MS, George Rodrigues, MD, PhD

    This guideline will update the recommendation on the use of concurrent chemotherapy in combination with palliative EBRT for patients with locally-advanced and advanced NSCLC based on new level 1 evidence published since the original guideline.

    Once complete, this document will partially update the original ASTRO palliative thoracic guideline.


    Stereotactic body radiotherapy for early-stage non-small cell lung cancer: An ASTRO evidence-based clinical practice guideline (publication anticipated in 2017)

    Authors: Gregory Videtic, MD, Jessica Doningham, MD, Meredith Giuliani, MD, John Heinzerling, MD, Tomer Karras, MD, Christopher Kelsey, MD, Brian Lally, MD, Simon Lo, MD, Drew Moghanaki, MD, Benjamin Movsas, MD, Andrea Rimner, MD, PhD, Michael Roach, MD, George Rodrigues, MD, Shervin Shirvani, MD, Charles Simone, MS, Robert Timmerman, MD, Megan Daly, MD

    This guideline will explore the appropriateness of SBRT based on various patient and tumor characteristics and offer recommendations on how to tailor SBRT to provide adequate dose for high risk tumors. It will also discuss the role of SBRT as salvage therapy after recurrence.

    These clinical practice statements were developed and published by ASTRO in cooperation with one or more other specialty societies.


     Evidence-based guideline with ASCO and AUA on hypofractionated radiation for localized prostate cancer (in progress-publication anticipated in 2018)

    Authors: Scott C. Morgan, MD, MSc, Howard Sandler, MD, MS, Daniel Barocas, MD, MPH, Soren Bentzen, PhD, DMSc, Mark Buyyounouski, MD, MS, Michael Chang, MD, Jason Efstathiou, MD, Per Halvorsen, PhD, Karen Hoffman, MD, Bridget Koontz, MD, Colleen Lawton MD, C. Mark Leyrer, MD, Daniel Lin, MD, D. Andrew Loblaw, MD, MSc, Michael Ray, MD

    This guideline will address both moderately hypofractionated (2.4-3.4 Gy per fraction) and ultra hypofractionated (5 Gy or more per fraction) external beam regimens and how they compare to conventional fractionation when delivered to the intact prostate. It will also discuss technical issues, including normal tissue dose constraints, treatment volumes, and use of image-guided and intensity-modulated radiotherapy.

    This guideline is currently under development.


    Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update (online publication September 2016, print publication November 2016)

    Authors: Abram Recht, Elizabeth A. Comen, Richard E. Fine, Gini F. Fleming, Patricia H. Hardenbergh, Alice Y. Ho, Clifford A. Hudis, E. Shelley Hwang, Jeffrey J. Kirshner, Monica Morrow, Kilian E. Salerno, George W. Sledge Jr, Lawrence J. Solin, Patricia A. Spears, Timothy J. Whelan, Mark R. Somerfield, Stephen B. Edge

    This update to the ASCO guideline on use of postmastectomy radiotherapy (PMRT) focused on key areas of ongoing controversy, including the use of PMRT for patient with one to three positive lymph nodes or who are undergoing neoadjuvant systemic therapy; selected technical aspects of PMRT, particularly the extent of regional nodal irradiation; and whether PMRT is indicated in women with T1-2 tumors and a positive sentinel node biopsy who do not undergo completion axillary lymph node dissection.

    Read the guideline


    Society of Surgical Oncology - American Society for Radiation Oncology - American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ (online publication June 2016, print publication September 2016)

    Authors: Monica Morrow, MD, Kimberly J. Van Zee, MD, Lawrence J. Solin, MD, Nehmat Houssami, MBBS, PhD, Mariana Chavez-MacGregor, MD, Jay R. Harris, MD, Janet Horton, MD, Shelley Hwang, MD, Peggy L. Johnson, M. Luke Marinovich, PhD, Stuart J. Schnitt, MD, Irene Wapnir, MD, Meena S. Moran, MD

    A multidisciplinary consensus panel developed recommendations on optimal negative margin width for ducatal carcinoma in situ treated with breast-conserving surgery and whole-breast irradiation based on a meta-analysis of margin width and ipsilateral breast tumor recurrence, as well as other published literature.

    Read the guideline


    Society of Surgical Oncology – American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stages I and II invasive breast cancer (print publication March 2014)

    Authors: Meena S. Moran, MD, Stuart J. Schnitt, MD, Armando E. Giuliano, MD, Jay R. Harris, MD, Seema A. Khan, MD, Janet Horton, MD, Suzanne Klimberg, MD, Mariana Chavez-MacGregor, MD, Gary Freedman, MD, Nehmat Houssami, MD, PhD, Peggy L. Johnson and Monica Morrow, MD

    This guideline examines the relationship between margin width and ipsilateral breast tumor recurrence and offers recommendations for defining appropriate margins in the setting of breast conserving surgery and adjuvant radiation therapy.

    Read the guideline


    Adjuvant and salvage radiotherapy after prostatectomy: ASTRO/AUA guideline (print publication August 2013)

    Authors: Richard K. Valicenti, MD, MBA, Ian Thompson Jr., MD, Peter Albertsen, MD, MS, Brian J. Davis, MD, PhD, S. Larry Goldenberg, MD, J. Stuart Wolf, MD, Oliver Sartor, MD, Eric Klein, MD, Carol Hahn, MD, Jeff Michalski, MD, MBA, Mack Roach III, MD, and Martha M Faraday, PhD

    This guideline’s purpose is to provide direction to clinicians and patients regarding the use of radiotherapy after prostatectomy in patients with and without evidence of prostate cancer recurrence.

    Read the executive summary

    These published ASTRO clinical practice statements that have been endorsed by other organizations


    Accelerated partial breast irradiation: Update of an ASTRO evidence-based consensus statement (online publication September 2016, print publication March 2017)

    Authors: Candace Correa, MD, Eleanor E. Harris, MD, Maria Cristina Leonardi, MD, Benjamin D. Smith, MD, Alphonse G. Taghian, MD, PhD, Alastair M. Thompson, MD, Julia White, MD, Jay R. Harris, MD

    This update discusses new literature since the original consensus statement was published in 2009, revises the "suitable," "cautionary," and "unsuitable" patient groups for APBI, and provides guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer. 

    Read the executive summary
    Read the full guideline

    This document updates the original ASTRO consensus statement on APBI.


    Radiation therapy for glioblastoma: An ASTRO evidence-based guideline (online publication March 2016, print publication July 2016)

    Authors: Alvin Cabrera, MD, John Kirkpatrick, MD, John Fiveash, MD, Helen Shih, MD, Eugene Koay, MD, Stephen Lutz, MD, Joshua Petit, MD, Samuel Chao, MD, Paul Brown, MD, Michael Vogelbaum, MD, PhD, David Reardon, MD, Arnab Chakravarti, MD, Patrick Wen, MD, Eric Chang, MD

    This guideline discusses the role of radiotherapy in both primary and recurrent settings, taking into account both disease and patient factors, including performance status and age.

    Read the executive summary
    Read the full guideline 


    The role of post-operative radiation therapy for endometrial cancer: An ASTRO evidence-based guideline (online publication March 2014, print publication May 2014)

    Authors: Ann Klopp, MD, PhD, Benjamin Smith, MD, Kaled Alektiar, MD, Alvin Cabrera, MD, Antonio Damato, PhD, Beth Erickson, MD, Gini Fleming, MD, David Gaffney, MD, PhD, Kathryn Greven, MD, Karen Lu, MD, David Miller, MD, David Moore, MD, Daniel Petereit, MD, Tracey Schefter, MD, William Small Jr., MD, Catheryn Yashar, MD, Akila N. Viswanathan, MD, MPH

    This guideline presents evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer.

    Read the executive summary
    Read the guideline


    Radiotherapeutic and surgical management for newly diagnosed brain metastasis/es: An American Society for Radiation Oncology evidence-based guideline (online publication January 2012, print publication July 2012)

    Authors: May N. Tsao, MD, Dirk Rades, MD, Andrew Wirth, MD, Simon S. Lo, MD, Brita L. Danielson, MD, Laurie E. Gaspar, MD, MBA, Paul W. Sperduto, MD, MPP, Michael A. Vogelbaum, MD, PhD, Jeffrey D. Radawski, MD, Jian Z. Wang, PhD, Michael T. Gillin, PhD, Najeeb Mohideen, MD, Carol A. Hahn, MD, and Eric L. Chang, MD

    This guideline systematically reviews the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases.

    Read the guideline

  • Request Endorsement by ASTRO

    ASTRO values the opportunity to endorse clinical practice statements that are developed by external organizations. For consideration, please complete the endorsement request form.
    Complete the form
  • Collaboration on clinical guideline development can improve the delivery and consistency of quality medical care. Collaborative guidelines are intended to minimize duplication of effort, increase guideline production and harmonize recommendations for the benefit of radiation oncology professionals and patients. Organizations that request to collaborate with ASTRO in the development of a clinical practice guideline will meet the following requirements:

    1. Propose a topic that has a reasonable amount of high-quality evidence and considerable variation in radiation oncology practice.
    2. Specify needed resources including costs, staff roles and responsibilities.
    3. Utilize a clinical guideline development process that is aligned with the IOM’s guideline development standards including: transparency, management of Conflicts of Interest, multidisciplinary composition of the guideline development group, systematic review of the evidence, description of evidence foundations for rating the strength of the recommendations, articulation of clear recommendations and identification of methods for updating and revising the guideline.
    4. Explicitly rate the strength of evidence and strength of recommendations. The guideline will need to include information about the rating of the strength of the evidence and the strength of recommendation.
    5. Provide ASTRO with the authority to offer meaningful input into the final document in a timeframe consistent with ASTRO’s clinical practice guideline processes, allowing a minimum of three months for review. There will need to be agreed upon formal review processes including expert review and/or public comment as well as Board approval.
    6. Specify dissemination approaches such as publication, copyrights and marketing. The guideline should be published in the lead organization’s journal and be an open access article. A joint press release from all societies will be released.
    7. Ability to opt out of the guideline if there are substantive concerns.

    We believe that these criteria will provide a reasonable framework for guiding decisions related to collaboration with other organizations in the development of clinical practice guidelines.

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