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Higgins KA , Simone CB 2nd , Amini A , Chetty IJ , Donington J , Edelman MJ , Chun SG , Kestin LL , Movsas B , Rodrigues GB , Rosenzweig KE , Slotman BJ , Rybkin II , Wolf A , Chang JY
American Radium Society Appropriate Use Criteria on Radiation Therapy for Extensive-Stage SCLC
J Thorac Oncol. 2021 Jan;16(1) :54-65
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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.
Notes
1556-1380 Expert Panel Thoracic Malignancies: Higgins, Kristin A Simone, Charles B 2nd Amini, Arya Chetty, Indrin J Donington, Jessica Edelman, Martin J Chun, Stephen G Kestin, Larry L Movsas, Benjamin Rodrigues, George B Rosenzweig, Kenneth E Slotman, Ben J Rybkin, Igor I Wolf, Andrea Chang, Joe Y Journal Article United States J Thorac Oncol. 2021 Jan;16(1):54-65. doi: 10.1016/j.jtho.2020.09.013. Epub 2020 Oct 1.