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. 2021 Jan;16(1):54-65.
doi: 10.1016/j.jtho.2020.09.013. Epub 2020 Oct 1.

American Radium Society Appropriate Use Criteria on Radiation Therapy for Extensive-Stage SCLC

Expert Panel Thoracic Malignancies:; Kristin A Higgins  1 , Charles B Simone 2nd  2 , Arya Amini  3 , Indrin J Chetty  4 , Jessica Donington  5 , Martin J Edelman  6 , Stephen G Chun  7 , Larry L Kestin  8 , Benjamin Movsas  4 , George B Rodrigues  9 , Kenneth E Rosenzweig  10 , Ben J Slotman  11 , Igor I Rybkin  12 , Andrea Wolf  10 , Joe Y Chang  7
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Free article

American Radium Society Appropriate Use Criteria on Radiation Therapy for Extensive-Stage SCLC

Expert Panel Thoracic Malignancies: et al. J Thorac Oncol. 2021 Jan.
Free article

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.

Keywords: Appropriateness criteria; Extensive stage; Prophylactic cranial irradiation; Small cell lung cancer; Thoracic radiation.

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