Addendum to the Radiation Oncology Clinical Guidelines

Medically necessary: for stage III NSCLC, definitive EBRT 60–70 Gy in 30–35 fractions using 3D conformal or IMRT; for stage III SCLC, definitive EBRT 60–70 Gy in 30–35 fractions (3D conformal or IMRT) or 45 Gy delivered twice daily (3D conformal or IMRT). Coverage is limited to stage III disease and definitive (curative) intent using only the specified doses/fractionations and techniques; other stages, regimens, techniques or palliative uses are not included, and no specific documentation requirements are stated.

"Non-Small Cell Lung Cancer (stage III): Definitive external beam radiation therapy to a dose of 60-70 Gy in 30-35 fractions using a 3D conformal technique or intensity-modulated radiation therapy (..."

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