Charles B Simone1, Jeffrey A Bogart2, Alvin R Cabrera3, Megan E Daly4, Nicholas J DeNunzio5, Frank Detterbeck6, Corinne Faivre-Finn7, Nancy Gatschet8, Elizabeth Gore9, Salma K Jabbour10, Tim J Kruser11, Bryan J Schneider12, Ben Slotman13, Andrew Turrisi14, Abraham J Wu15, Jing Zeng16, Kenneth E Rosenzweig17. 1. New York Proton Center, New York, NY. 2. Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY. 3. Department of Radiation Oncology, Kaiser Permanente, Seattle, WA. 4. Department of Radiation Oncology, University of California Davis, Sacramento, CA. 5. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA. 6. Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT. 7. Division of Cancer Science, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom. 8. Patient representative, San Diego, CA. 9. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI. 10. Department of Radiation Oncology, Rutgers University, New Brunswick, NJ. 11. Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL. 12. Department of Medical Oncology, University of Michigan, Ann Arbor, MI. 13. Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands. 14. Department of Radiation Oncology, James H. Quillen VA Medical Center, Mountain Home, TN. 15. Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY. 16. Department of Radiation Oncology, University of Washington, Seattle, WA. 17. Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY. Electronic address: kenneth.rosenzweig@mountsinai.org.
Abstract
PURPOSE: Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS: RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
RCT Entities:
PURPOSE: Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS: RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
Authors: C Faivre-Finn; J D Fenwick; K N Franks; S Harrow; M Q F Hatton; C Hiley; J J McAleese; F McDonald; J O'Hare; C Peedell; T Pope; C Powell; R Rulach; E Toy Journal: Clin Oncol (R Coll Radiol) Date: 2020-05-13 Impact factor: 4.126
Authors: Sondos Zayed; Hanbo Chen; Emma Ali; George B Rodrigues; Andrew Warner; David A Palma; Alexander V Louie Journal: Int J Radiat Oncol Biol Phys Date: 2020-06-13 Impact factor: 7.038
Authors: Michael Yan; Tzen S Toh; Patricia E Lindsay; Jessica Weiss; Katrina Hueniken; Christy Yeung; Vijithan Sugumar; Dixon Pinto; Tony Tadic; Alexander Sun; Andrea Bezjak; John Cho; Srinivas Raman; Meredith Giuliani; Fabio Ynoe Moraes; Geoffrey Liu; Andrew J Hope; Benjamin H Lok Journal: Clin Transl Radiat Oncol Date: 2021-07-08