Many individuals whose lung cancer has spread receive radiation therapy to take care of symptoms related to cancer, such as for example cough, shortness of breath, bronchial obstruction and chest pain. However, the exact treatment approach can vary from doctor to doctor. This variation caused the Guidelines Subcommittee of ASTRO’s Clinical Affairs and Quality Committee to recognize the use of palliative thoracic radiation therapy as a high-priority topic needing an evidence-structured guideline. This panel was co-chaired by George Rodrigues, MD, MSc, a radiation oncologist and clinician scientist at London Health Sciences Centre in London, Ontario, Canada, and Benjamin Movsas, MD, chairman of radiation oncology at Henry Ford Health Program in Detroit.In the decade because the publication of this article, there were many adjustments in the management of sepsis, raising the question of whether all components of the protocol remain necessary.5-7 To address this question, we designed a multicenter trial comparing choice resuscitation strategies in a wide cohort of patients with septic shock. Particularly, we examined whether protocol-based resuscitation was superior to usual care and whether a process with central hemodynamic monitoring to guide the usage of fluids, vasopressors, blood transfusions, and dobutamine was more advanced than a simpler protocol that did not include these elements. Methods Study Oversight We conducted the multicenter, randomized Protocolized Look after Early Septic Shock trial at 31 hospitals in the United States.