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. 2021 Jan;16(1):66-75.
doi: 10.1016/j.jtho.2020.10.020. Epub 2020 Nov 6.

American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

Stephen G Chun  1 , Charles B Simone 2nd  2 , Arya Amini  3 , Indrin J Chetty  4 , Jessica Donington  5 , Martin J Edelman  6 , Kristin A Higgins  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  13 , Joe Y Chang  14
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Free article

American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

Stephen G Chun et al. J Thorac Oncol. 2021 Jan.
Free article

Abstract

Introduction: Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC.

Methods: The ARS AUC 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 application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization.

Results: The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1-directed immune therapy should not be routinely administered outside the context of clinical trials at this time.

Conclusions: The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.

Keywords: ARS; AUC; Limited-stage SCLC; Lung cancer.

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