Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines

Purpose: The National Comprehensive Cancer Network (NCCN) clinical guidelines influence medical practice, payor coverage, and standards of care. The levels of evidence underlying radiation therapy recommendations in NCCN have not been systematically explored. Herein, we aim to systematically investi...

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Autores principales:	Miguel Angel Noy, BS, Benjamin J. Rich, MD, Ricardo Llorente, MD, Deukwoo Kwon, PhD, Matthew Abramowitz, MD, Brandon Mahal, MD, Eric A. Mellon, MD, PhD, Nicholas G. Zaorsky, MD, MS, Alan Dal Pra, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/dbe13f175bcc47db9365ddb61c2490d7
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spelling	oai:doaj.org-article:dbe13f175bcc47db9365ddb61c2490d72021-11-24T04:32:47ZLevels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines2452-109410.1016/j.adro.2021.100832https://doaj.org/article/dbe13f175bcc47db9365ddb61c2490d72022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2452109421001901https://doaj.org/toc/2452-1094Purpose: The National Comprehensive Cancer Network (NCCN) clinical guidelines influence medical practice, payor coverage, and standards of care. The levels of evidence underlying radiation therapy recommendations in NCCN have not been systematically explored. Herein, we aim to systematically investigate the NCCN recommendations pertaining to the categories of consensus and evidence (CE) for radiation therapy. Methods and Materials: We evaluated the distribution of CE underlying current treatment recommendations for the 20 most prevalent cancers in the United States with at least 10 radiation therapy recommendations in the NCCN clinical guidelines. For context, the distribution of evidence in the radiation therapy guidelines was compared with that of systemic therapy using a χ2 test. The proportion of category I CE between radiation and systemic therapy was compared using a 2-proportion, 2-tailed z-test in total and for each disease site. A P value of < .05 was considered significant. Results: Among all radiation therapy recommendations, the proportions of category I, IIA, IIB, and III CE were 9.7%, 80.6%, 8.4%, and 1.3%, respectively. When analyzed by disease site, cervix and breast cancer had the highest portion of category I CE (33% and 31%, respectively). There was no radiation therapy category I CE for hepatobiliary, bone, pancreatic, melanoma, and uterine cancers. There was a significant difference in the distribution of CE between the systemic therapy recommendations and the radiation therapy recommendations (χ2 statistic 64.16, P < .001). Overall, there was a significantly higher proportion of category I CE in the systemic therapy recommendations compared with the radiation therapy recommendations (12.3% vs 9.7%, P = .043). Conclusions: Only 9.7% of radiation therapy recommendations in NCCN guidelines are category I CE. The highest levels of evidence for radiation therapy are in breast and cervical cancers. Despite major advances in the field, these data underline that the majority of NCCN radiation therapy recommendations are based on uniform expert opinion and not on higher level evidence.Miguel Angel Noy, BSBenjamin J. Rich, MDRicardo Llorente, MDDeukwoo Kwon, PhDMatthew Abramowitz, MDBrandon Mahal, MDEric A. Mellon, MD, PhDNicholas G. Zaorsky, MD, MSAlan Dal Pra, MDElsevierarticleMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENAdvances in Radiation Oncology, Vol 7, Iss 1, Pp 100832- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Miguel Angel Noy, BS Benjamin J. Rich, MD Ricardo Llorente, MD Deukwoo Kwon, PhD Matthew Abramowitz, MD Brandon Mahal, MD Eric A. Mellon, MD, PhD Nicholas G. Zaorsky, MD, MS Alan Dal Pra, MD Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
description	Purpose: The National Comprehensive Cancer Network (NCCN) clinical guidelines influence medical practice, payor coverage, and standards of care. The levels of evidence underlying radiation therapy recommendations in NCCN have not been systematically explored. Herein, we aim to systematically investigate the NCCN recommendations pertaining to the categories of consensus and evidence (CE) for radiation therapy. Methods and Materials: We evaluated the distribution of CE underlying current treatment recommendations for the 20 most prevalent cancers in the United States with at least 10 radiation therapy recommendations in the NCCN clinical guidelines. For context, the distribution of evidence in the radiation therapy guidelines was compared with that of systemic therapy using a χ2 test. The proportion of category I CE between radiation and systemic therapy was compared using a 2-proportion, 2-tailed z-test in total and for each disease site. A P value of < .05 was considered significant. Results: Among all radiation therapy recommendations, the proportions of category I, IIA, IIB, and III CE were 9.7%, 80.6%, 8.4%, and 1.3%, respectively. When analyzed by disease site, cervix and breast cancer had the highest portion of category I CE (33% and 31%, respectively). There was no radiation therapy category I CE for hepatobiliary, bone, pancreatic, melanoma, and uterine cancers. There was a significant difference in the distribution of CE between the systemic therapy recommendations and the radiation therapy recommendations (χ2 statistic 64.16, P < .001). Overall, there was a significantly higher proportion of category I CE in the systemic therapy recommendations compared with the radiation therapy recommendations (12.3% vs 9.7%, P = .043). Conclusions: Only 9.7% of radiation therapy recommendations in NCCN guidelines are category I CE. The highest levels of evidence for radiation therapy are in breast and cervical cancers. Despite major advances in the field, these data underline that the majority of NCCN radiation therapy recommendations are based on uniform expert opinion and not on higher level evidence.
format	article
author	Miguel Angel Noy, BS Benjamin J. Rich, MD Ricardo Llorente, MD Deukwoo Kwon, PhD Matthew Abramowitz, MD Brandon Mahal, MD Eric A. Mellon, MD, PhD Nicholas G. Zaorsky, MD, MS Alan Dal Pra, MD
author_facet	Miguel Angel Noy, BS Benjamin J. Rich, MD Ricardo Llorente, MD Deukwoo Kwon, PhD Matthew Abramowitz, MD Brandon Mahal, MD Eric A. Mellon, MD, PhD Nicholas G. Zaorsky, MD, MS Alan Dal Pra, MD
author_sort	Miguel Angel Noy, BS
title	Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
title_short	Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
title_full	Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
title_fullStr	Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
title_full_unstemmed	Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines
title_sort	levels of evidence for radiation therapy recommendations in the national comprehensive cancer network (nccn) clinical guidelines
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/dbe13f175bcc47db9365ddb61c2490d7
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Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines

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