Radiation Oncology/SCLC/Extensive Stage

Extensive Stage Small Cell Lung Cancer Consensus guidelines American Radium Society Appropriate Use Criteria on Radiation Therapy for Extensive-Stage SCLC 2020 33011389 – Higgins KA et al., J Thorac Oncol Evidence-based guidelines for specific extensive-stage SCLC variants rated by multidisciplinary expert panel Conclusions: Current evidence supports either prophylactic cranial irradiation or surveillance with magnetic resonance imaging every 3 months for patients without evidence of brain metastases Patients with brain metastases should receive whole-brain radiation with a recommended dose of 30 Gy in 10 fractions Consolidative thoracic radiation can be considered in selected cases with the recommended dose ranging from 30 to 54 Gy Consolidation Thoracic Radiotherapy Kragujevac, Yugoslavia (1988-1993) -- Consolidation chemoradiation vs consolidation cisplatin/etoposide Randomized. 210 patients treated w/ 3 cycles of cisplatin/etoposide (PE). Pts w/ distant-CR + local-CR/PR randomized to RT (54 Gy in 36 fx over 18 days) with concurrent carboplatin/etoposide followed by 2 more cycles of PE vs 4 additional cycles of PE. 1999 10561263 "Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study." (Jeremic B et al. J Clin Oncol. 1999 Jul;17(7):2092-9.) Outcome: Median OS RT 17 months vs chemo 11 months (SS); 5-year OS 9% vs 4%. No difference in DMFS. Conclusion: Patients with good response to initial chemo may have improved overall survival with consolidative RT Slotman (2009-2012) -- Consolidation chest RT vs no chest RT Randomized. 498 patients, 42 hospitals in Europe, treated w/ 4-6 cycles cisplatin/etoposide (PE). Pts w/ any response randomized PCI + thoracic RT vs PCI alone. PCI 20Gy/5fxs, 25Gy/10fxs, 30Gy/10,12,15 fxs (institution allowed only one regimen). Thoracic RT 30Gy/10fxs. PTV post-chemo volume +15mm margin, hilar and mediastinal nodal stations involved pre-chemo always included 2015 25230595 "Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial" (Slotman BJ et al. Lancet 2015 Jan 3;385(9962):36-42) Outcome: Median FU 24 months. 1 year OS thoracic RT 33% vs 28% no thoracic RT (p=0.066). 2 year OS 13% vs 3% (p=0·004). 6 month PFS 24% vs 7% (p=0·001) Conclusion: "Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy."