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ASTRO's Role in NCCN Guidelines

By Sandra Zaky, MD, MS, former ASTRO Guideline Subcommittee Chair (2018-2022)
Posted: May 24, 2023

Have you ever wondered how ASTRO guidelines are created? For the last 15 years, ASTRO has been committed to creating evidence-based guidelines to help support members’ clinical decisions. Since that time, the ASTRO Guideline Subcommittee (GLSC) has created 28 disease-site specific guidelines. ASTRO has also collaborated with other societies to develop joint guidelines on a number of multidisciplinary topics. I recently served as the chair of the GLSC and want to share what I learned and promote how to get involved.

To become a member of the GLSC is an honor but also a commitment to the integrity of the guidelines process. ASTRO members apply through the regular committee nomination process (which occurs annually in the Spring, closing this year on Friday, June 2) for an annual term that can be renewed for up to five years, if selected. The GLSC meets once a month for one hour, where we discuss the current and future potential guidelines. The GLSC proposes a future guideline topic to the ASTRO Board, and once approved, a multidisciplinary task force of experts is selected. In general, GLSC members may or may not serve as guideline panelists themselves, and this will depend on the individual’s clinical expertise and the topics that are being developed. Additionally, we consider collaborative guidelines with other societies such as ASCO, AUA and SSO, to name a few.

In addition to creating new guidelines, the GLSC evaluates guidelines once they are two years post-publication to determine if updates are needed. ASTRO also updates any guideline that is more than five years old. The guideline development process is rigorous and involves significant planning. You can review a thorough description of all the steps in the process and read through ASTRO’s methodology guide for more details.

Since the inception of the GLSC, ASTRO guidelines have become integral in the treatment algorithms for a large percentage of ASTRO members. In surveys conducted between 2018 and 2022, ASTRO members have consistently rated guidelines in the top five offerings providing value to members. Guidelines are located in the Patient Care and Research section of ASTRO’s website, which is the second busiest on the site, accounting for 40% of all visits to that section. In Practical Radiation Oncology, which publishes all ASTRO guidelines, four of the five most cited articles for the past three years are guidelines. Jump to FAQs about ASTRO guidelines.

What is the relationship between ASTRO and NCCN guidelines?

Similar to ASTRO’s commitment to evidence-based guidelines, the National Comprehensive Cancer Network (NCCN) was created in 1993 to ensure delivery of high-quality, cost-effective services to people with cancer. NCCN guidelines provide evidence-based, consensus-driven recommendations across all oncology care and throughout the world. The make up of each disease site committee varies, but most include medical oncology, surgery, pathology, radiology and radiation oncology representatives. Radiation oncologists’ participation in NCCN guideline panels range from zero to 11 per committee.

To increase the visibility of these exhaustive guidelines, improve radiation oncology contributions to disease sites, and evaluate the concordance between NCCN and ASTRO recommendations, the GLSC initiated a collaborative relationship with the NCCN. In 2015, ASTRO began providing formal reviews of the radiation oncology content for approximately three NCCN guidelines per year.

These NCCN reviews have become a strategic component of topic prioritization for ASTRO. They can be drivers for ASTRO’s own topic prioritization or facilitate key question development if an area is not well represented in an NCCN guideline. The NCCN guideline review provides additional radiation oncology feedback on key developments or interventions especially when an NCCN panel has few or no radiation oncology participants. These reviews also ensure that the radiation therapy components included in NCCN guidelines are of the highest quality for all stakeholders since their guidelines are a central reference for oncology guidance.

The review process takes approximately three to four months and is performed by members of the GLSC. Key findings of the review are documented and sent to the GLSC for a final review. The final version is approved by ASTRO’s Clinical Affairs Quality Committee and then submitted to NCCN at least three weeks prior to the relevant NCCN guideline meeting.

Since this relationship began, the NCCN has implemented changes on every topic submitted by the GLSC. Accepted changes range from 23% to 100% of ASTRO recommendations per guideline. Many of these changes are impactful to the treatment algorithm. And, even more recently, once an ASTRO guideline is approved and published, the published link is submitted to the NCCN for inclusion into the updated NCCN guideline. This collaboration improves the radiation therapy component of the NCCN guidelines and makes the ASTRO guidelines more visible to the entire oncology community. Further, since many benefit managers refer to the NCCN guidelines, the GLSC is having a positive impact on patient access to needed services.

It was an honor to lead the GLSC, and I encourage ASTRO members to become involved too. Volunteering for the committee or on a guideline task force, participating as a formal peer reviewer or providing feedback during public comment are examples of ways you can contribute to the success of ASTRO guidelines.

Guideline Development Frequently Asked Questions

Who makes up the members of the ASTRO Guideline Subcommittee (GLSC)?
ASTRO members, such as radiation oncologists and physicists who volunteer their time, and ASTRO staff.

How many members are on the GLSC?
28-30 volunteers.

How many disease site-specific guidelines are created each year by the GLSC? Four to five guidelines.

Where can I find the ASTRO guidelines on the ASTRO website?
Guidelines live under the Patient Care & Research section of astro.org.

How can I participate in guideline development?

  1. Volunteer on the Guideline Subcommittee.
  2. Volunteer to be on a task force.
  3. Keep an eye out in ASTROgrams for guidelines that are out for Public Comment and submit your feedback.
  4. If you are on a NCCN committee, consider reviewing the ASTRO guidelines for that disease site.


Topics:  ASTRO Guidelines
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