Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline

Simone, Charles B.; Bogart, Jeffrey A.; Cabrera, Alvin R.; Daly, Megan E.; DeNunzio, Nicholas J.; Detterbeck, Frank C.; Faivre-Finn, Corinne; Gatschet, Nancy; Gore, Elizabeth; Jabbour, Salma K.; Kruser, Tim J.; Schneider, Bryan J.; Slotman, Ben J.; Turrisi, Andrew T.; Wu, Abraham J.; Zeng, Jing; Rosenzweig, Kenneth E.

doi:10.1016/j.prro.2020.02.009

Cited by 141 publications

(151 citation statements)

References 105 publications

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“…Currently, PCI is a category 1 recommendation after at least a partial response to thoracic radiation, according to the National Comprehensive Cancer Network and the American Society for Radiation Oncology guidelines. 4 These recommendations are based primarily on a large meta-analysis 5 of LS-SCLC trials showing a 5.4% OS benefit associated with PCI. However, most of the data on this topic, including that meta-analysis, were published before the routine use of MRI for staging, which has superior sensitivity in detecting brain metastasis (BM) compared with computed tomography.…”

Section: Introductionmentioning

confidence: 99%

Rates of Overall Survival and Intracranial Control in the Magnetic Resonance Imaging Era for Patients With Limited-Stage Small Cell Lung Cancer With and Without Prophylactic Cranial Irradiation

et al. 2020

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IMPORTANCE Historical data suggest that there is an overall survival benefit associated with prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC). However, as the fidelity of magnetic resonance imaging (MRI) of the brain continues to improve, this idea is now being questioned, with recent research showing no survival benefit associated with PCI in extensive-stage SCLC; however, the role for PCI is not clear in patients with limited-stage SCLC (LS-SCLC).OBJECTIVE To report the overall survival and rates of intracranial control for patients with LS-SCLC, all staged with MRI, who either did or did not undergo PCI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 297 patients with LS-SCLC at alarge US academic cancer center. Patients were treated with thoracic radiation; 205 also underwent PCI and 92 did not. All patients underwent at least baseline MRI, with restaging brain MRI and/or computed tomography; they did not have disease progression after thoracic radiation treatment. A propensity score-matching analysis was undertaken in an attempt to adjust for potential bias. Of the 297 patients who met the inclusion criteria, the propensity score was calculated for 295 patients, using patient, tumor, and treatment characteristics. Data were analyzed in October 2019. INTERVENTION Prophylactic cranial irradiation in patients with LS-SCLC. MAIN OUTCOMES AND MEASURESThe rate of overall survival and intracranial control. RESULTSOf the 297 patients, 162 (54.5%) were men. The median age was 62.2 years (range, 27.0-85.0 years) for patients who underwent PCI and 68.6 years (range, 40.0-86.0 years) for those who did not undergo PCI. The 3-year cumulative incidence rate of brain metastases was higher in the no-PCI group vs the PCI group, when counting death as a competing risk, but the difference was not statistically significant (20.40% [95% CI, 12.45%-29.67%] vs 11.20% [95% CI, 5.40%-19.20%]; P = .10). The use of PCI was not associated with a difference in overall survival between the patient groups (hazard ratio, 0.844; 95% CI, 0.604-1.180; P = .32). CONCLUSIONS AND RELEVANCEThese findings suggest that patients with LS-SCLC staged with MRI who undergo PCI after thoracic radiation treatment were not associated with a decreased risk of developing new brain metastases compared with patients who do not undergo PCI. The use of PCI was not associated with an overall survival benefit for such patients. 17. Ozawa Y, Omae M, Fujii M, et al. Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. BMC Cancer. 2015;15(587):589.

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Section: Introductionmentioning

confidence: 99%

Rates of Overall Survival and Intracranial Control in the Magnetic Resonance Imaging Era for Patients With Limited-Stage Small Cell Lung Cancer With and Without Prophylactic Cranial Irradiation

et al. 2020

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“…Their conclusion was that the addition of CTRT to the treatment of the most favorable subset of ES-SCLC patients led to improved survival over that obtained with chemotherapy alone. This was further confirmed by the American Society for Radiation Oncology (ASTRO) guidelines, but the recommended dose was 30 Gy in 10 fractions [ 18 ].…”

Section: Discussionmentioning

confidence: 71%

“…However, only 26 (10.4%) patients received CTRT and only 17 (6.8%) patients underwent PCI which had not become standard at the time of the study but should have increased the difference of OS in the first two subgroups of their cohort [ 17 ]. More aggressive treatment should have been offered based on current guidelines [ 4 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Case of Complete Remission from Palliative Radiation in Extensive Stage Small Cell Lung Cancer With Large Brain Metastasis Nine Years After Diagnosis: Cure Is Possible

Pan

2020

Cureus

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Extensive stage small cell lung cancer (ES-SCLC) with symptomatic brain metastasis (BM) carries very poor prognosis with a median survival of only three to four months. This case shows the potential benefit of offering aggressive multimodality treatment to achieve the best quality of life and to improve survival. A complete response (CR) was achieved following craniotomy, whole brain irradiation (WBI), palliative chemotherapy, and palliative consolidative thoracic radiotherapy (CTRT) for ES-SCLC with large symptomatic BM. There was no residual cancer or further metastasis seen on CT imaging. The patient remains cancer free and asymptomatic nine years after the initial diagnosis.

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“…Several retrospective analyses also suggested that TRT in combination with chemotherapy was associated with long-term survival [9][10][11][12][13]. Recently, the additional use of TRT has been strongly advocated for certain ES-SCLC patients after chemotherapy treatment in the 2020 NCCN guidelines [14] and in the ASTRO 2020 guidelines [15].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Extensive Stage Small Cell Lung Cancer Patients Treated With Thoracic Radiotherapy at Different Timing and Fractionation

Han

2020

Preprint

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Objective: The purpose of this study was to assess whether combined thoracic radiotherapy (TRT) on the basis of chemotherapy (ChT) showed promising anti-tumor activity in extensive-stage small cell lung cancer (ES-SCLC), then to explore practice patterns for radiation time and dose/ fractionation and to identify prognostic factors for patients who would benefit from ChT/TRT.Methods: A total of 492 ES-SCLC patients were included from January 2010 to March 2019, of which 244 patients experienced ChT/TRT. Propensity score matching (PSM) was performed to minimize bias between the ChT/TRT and ChT-alone groups. Patients in ChT/TRT group were categorized into four groups based on the number of induction chemotherapy cycles. For effective dose fractionation calculation, we introduced the time-adjusted biological effective dose(tBED). Categorical variables were analyzed with Chi-square tests and Fisher’s exact tests. Survival rates were computed by the Kaplan-Meier method. Multivariate prognostic analysis was performed with Cox proportional hazard models. Results: Patients who received ChT/TRT were associated with improved OS (18.2 vs 10.8 months), PFS (9.0 vs 6.0 months) and LRFS (12.0 vs 6.0 months) before matching, with similar results after matching. In the ChT/TRT group, the median LRFS times for groups based on radiation time were 12.7, 12.0, 12.7, and 9.0 months, respectively. Earlier TRT had a tendency to prolong PFS (median 10.6 vs 9.8 vs 9.1 vs 7.7 months, respectively, p = 0.1095), as was not seen in OS (median 17.6 vs 19.5 vs 17.2 vs 19.1 months, respectively, p = 0.7224). To note, patients within 6 cycles had better LRFS (p = 0.0006). For radiation dose, patients in high-dose group (tBED>50Gy) had worse OS (median 25.9 vs 22.9, p = 0.0484) and PFS (median 12.1 vs 11.2, p=0.0042) in patients with complete response and partial response (CR and PR) to systemic therapy, but the above-mentioned results were not drawn when the population was confined to those receiving standard fractionation with CR and PR. Conclusion: ChT/TRT could improve survival for ES-SCLC patients. We cautiously recommend that TRT should be performed within 6 cycles and receiving hyperfractionated 45Gy in 30 fractions may be a feasible treatment scheme for ES-SCLC patients.

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Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline

Cited by 141 publications

References 105 publications

Rates of Overall Survival and Intracranial Control in the Magnetic Resonance Imaging Era for Patients With Limited-Stage Small Cell Lung Cancer With and Without Prophylactic Cranial Irradiation

Rates of Overall Survival and Intracranial Control in the Magnetic Resonance Imaging Era for Patients With Limited-Stage Small Cell Lung Cancer With and Without Prophylactic Cranial Irradiation

Case of Complete Remission from Palliative Radiation in Extensive Stage Small Cell Lung Cancer With Large Brain Metastasis Nine Years After Diagnosis: Cure Is Possible

Clinical Outcomes of Extensive Stage Small Cell Lung Cancer Patients Treated With Thoracic Radiotherapy at Different Timing and Fractionation

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