Kristin A Higgins1, Charles B Simone2, Arya Amini3, Indrin J Chetty4, Jessica Donington5, Martin J Edelman6, Stephen G Chun7, Larry L Kestin8, Benjamin Movsas4, George B Rodrigues9, Kenneth E Rosenzweig10, Ben J Slotman11, Igor I Rybkin12, Andrea Wolf10, Joe Y Chang7. 1. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. Electronic address: Kristin.higgins@emory.edu. 2. New York Proton Center, New York, New York. 3. Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California. 4. Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan. 5. Department of Thoracic Surgery, The University of Chicago, Chicago, Illinois. 6. Department of Medical Oncology, Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania. 7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 8. Department of Radiation Oncology, MHP Cancer Institute, Pontiac, Michigan. 9. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. 10. Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York. 11. Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands. 12. Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; Department of Medical Oncology, Henry Ford Health System, Detroit, Michigan.
Abstract
INTRODUCTION: The standard-of-care therapy for extensive-stage SCLC has recently changed with the results of two large randomized trials revealing improved survival with the addition of immunotherapy to first-line platinum or etoposide chemotherapy. This has led to a lack of clarity around the role of consolidative thoracic radiation and prophylactic cranial irradiation in the setting of chemoimmunotherapy. METHODS: The American Radium Society Appropriate Use Criteria are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with the application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for extensive-stage SCLC. RESULTS: 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; this recommendation was driven by expert opinion owing to the limited strength of evidence, as clinical trials addressing this question remain ongoing. CONCLUSIONS: Radiation therapy remains an integral component in the treatment paradigm for ES-SCLC.
INTRODUCTION: The standard-of-care therapy for extensive-stage SCLC has recently changed with the results of two large randomized trials revealing improved survival with the addition of immunotherapy to first-line platinum or etoposide chemotherapy. This has led to a lack of clarity around the role of consolidative thoracic radiation and prophylactic cranial irradiation in the setting of chemoimmunotherapy. METHODS: The American Radium Society Appropriate Use Criteria are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with the application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for extensive-stage SCLC. RESULTS: 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; this recommendation was driven by expert opinion owing to the limited strength of evidence, as clinical trials addressing this question remain ongoing. CONCLUSIONS: Radiation therapy remains an integral component in the treatment paradigm for ES-SCLC.
Authors: Alyssa Y Li; Karolina Gaebe; Katarzyna J Jerzak; Parneet K Cheema; Arjun Sahgal; Sunit Das Journal: Front Oncol Date: 2022-03-07 Impact factor: 6.244