Expert Discusses Radiotherapy Recommendations for SCLC Management

Radiotherapy delivered at a maximum of 45 Gy twice a day or at 60 Gy to 70 Gy once a day appears to be acceptable and comparable to each other in the treatment of patients with limited-stage small cell lung cancer (LS-SCLC), according to Gregory Peter Kalemkerian, MD in a conversation with CancerNetwork^®.

Kalemkerian, a clinical professor at The University of Michigan, discussed what updated guidelines from the American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario) highlighted about the role radiation therapy may play in the treatment of those with SCLC.¹ He was the senior author of the updated guidelines.

With respect to managing brain metastases among this patient population, Kalemkerian said that there have been conflicting data concerning prophylactic cranial irradiation for those with extensive-stage disease. In place of this procedure, it is recommended that practices perform MRI surveillance followed by radiotherapy if patients develop brain metastases.

Guideline authors issued a strong recommendation based on high-quality evidence that clinicians may administer cisplatin plus etoposide concurrently with radiotherapy for patients with LS-SCLC.¹ Another strong recommendation based on low-quality evidence was issued for administering carboplatin plus etoposide for patients with LS-SCLC and contraindications to cisplatin.

Transcript:

We endorsed the American Society for Radiation Oncology [ASTRO] guidelines for radiotherapy. The radiotherapy advances in this stage of disease have been in refining how to deliver radiotherapy to people with limited-stage disease, whether doing early concurrent radiotherapy is better than later or sequential [treatment]. The question of whether we do hyperfractionated radiation, meaning twice-a-day or once-a-day radiation, despite several trials—some of which were very well done—remains an open question. Now, either doing twice-a-day radiation up to a total dose of 45 Gy or once-a-day radiation up to a dose of 60 Gy to 70 Gy is considered acceptable and probably equivalent to each other.

Then you have the question of brain radiation. In SCLC, 60% of people will develop brain metastases.² The issue is [whether we should] do prophylactic brain radiation to try to prevent symptomatic brain metastases in [patients]. In limited-stage disease, that is a standard of care because it did improve 3-year overall survival by about 5%, and that’s essentially improving the cure rate in that disease. In extensive-stage disease, there have been conflicting data on the role of prophylactic cranial irradiation [PCI]. Many of us, especially those in medical oncology, do not believe that it’s worthwhile in patients with extensive-stage [disease], and we prefer to do MRI surveillance on those individuals and then use radiotherapy if they develop brain metastases and keep catching it early by doing the MRI surveillance. That’s where radiotherapy is right now.

References

1. Khurshid H, Ismaila N, Bian J, et al. Systemic therapy for small-cell lung cancer: ASCO-Ontario Health (Cancer Care Ontario) guideline. J Clin Oncol. 2023;41(35):5448-5472. doi:10.1200/JCO.23.01435
2. Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer. 2008; 112:1827-1834, 2008;112(8):1827-1834. doi:10.1002/cncr.23361.