The American Society for Radiation Oncology (ASTRO) expanded on its recommendations for the national Choosing Wisely campaign, adding five targeted treatment options to the list of procedures that should be carefully scrutinized before being prescribed.

Choosing Wisely is an initiative from the American Board of Internal Medicine Foundation aimed at promoting care supported by evidence and discouraging procedures that are unnecessary, duplicative or harmful. ASTRO released its first list of five recommendations in September 2013.

This year, ASTRO added the following five recommendations:

• Don’t recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease.
• Don’t routinely offer radiation therapy for patients who have resected non-small cell lung cancer, negative margins, N0-1 disease.
• Don’t initiate non-curative radiation therapy without defining the goals of treatment with the patient and considering palliative care referral.
• Don’t routinely recommend follow-up mammograms more often than annually for women who have had radiotherapy following breast conserving surgery.
• Don’t routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases.

An ASTRO work group narrowed a list of potential recommendations down to nine items, which were included in a survey sent to ASTO members. The survey results were sent to ASTRO’s Board of Directors, and after the work group conducted a review of the literature, the Board approved the final items for inclusion.