Current Management and Progress in Radiotherapy for Small Cell Lung Cancer
Radiotherapy (RT) and chemotherapy continue to be widely utilized in small cell lung cancer (SCLC) management. In most limited stage (LS)-SCLC cases, the standard initial therapy remains concurrent chemoradiotherapy (CRT), typically with an etoposide and platinum-based regimen. Hyperfractionated twi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.01146/full |
| _version_ | 1818281695415107584 |
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| author | Michael C. Tjong David Y. Mak Jeevin Shahi George J. Li Hanbo Chen Alexander V. Louie |
| author_facet | Michael C. Tjong David Y. Mak Jeevin Shahi George J. Li Hanbo Chen Alexander V. Louie |
| author_sort | Michael C. Tjong |
| collection | DOAJ |
| description | Radiotherapy (RT) and chemotherapy continue to be widely utilized in small cell lung cancer (SCLC) management. In most limited stage (LS)-SCLC cases, the standard initial therapy remains concurrent chemoradiotherapy (CRT), typically with an etoposide and platinum-based regimen. Hyperfractionated twice daily (BID) RT remains the standard of care, though conventional daily (QD) RT is now a viable alternative supported by randomized evidence. In LS-SCLC patients who experienced good response to CRT, prophylactic cranial irradiation (PCI) remains the standard of care. Brain imaging, ideally with MRI, should be performed prior to PCI to screen for clinically apparent brain metastases that may require a higher dose of cranial irradiation. Platinum doublet chemotherapy alone is the historic standard initial therapy in extensive stage (ES)-SCLC. Addition of immunotherapy such as atezolizumab and durvalumab to chemotherapy is now recommended after their benefits were demonstrated in recent trials. In patients with response to chemotherapy, consolidation thoracic RT and PCI could be considered, though with caveats. Emergence of hippocampal avoidance cranial irradiation and SRS in SCLC patients may supplant whole cranial irradiation as future standards of care. Incorporation of novel systemic therapies such as immunotherapies has changed the treatment paradigm and overall outlook of patients with SCLC. This narrative review summarizes the current state, ongoing trials, and future directions of radiotherapy in management of SCLC. |
| first_indexed | 2024-12-13T00:09:12Z |
| format | Article |
| id | doaj.art-c7ba795ec07b4858ad74821fe513cb97 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-13T00:09:12Z |
| publishDate | 2020-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c7ba795ec07b4858ad74821fe513cb972022-12-22T00:06:05ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-07-011010.3389/fonc.2020.01146545968Current Management and Progress in Radiotherapy for Small Cell Lung CancerMichael C. Tjong0David Y. Mak1Jeevin Shahi2George J. Li3Hanbo Chen4Alexander V. Louie5Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaDepartment of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaDepartment of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaFaculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaDepartment of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaRadiotherapy (RT) and chemotherapy continue to be widely utilized in small cell lung cancer (SCLC) management. In most limited stage (LS)-SCLC cases, the standard initial therapy remains concurrent chemoradiotherapy (CRT), typically with an etoposide and platinum-based regimen. Hyperfractionated twice daily (BID) RT remains the standard of care, though conventional daily (QD) RT is now a viable alternative supported by randomized evidence. In LS-SCLC patients who experienced good response to CRT, prophylactic cranial irradiation (PCI) remains the standard of care. Brain imaging, ideally with MRI, should be performed prior to PCI to screen for clinically apparent brain metastases that may require a higher dose of cranial irradiation. Platinum doublet chemotherapy alone is the historic standard initial therapy in extensive stage (ES)-SCLC. Addition of immunotherapy such as atezolizumab and durvalumab to chemotherapy is now recommended after their benefits were demonstrated in recent trials. In patients with response to chemotherapy, consolidation thoracic RT and PCI could be considered, though with caveats. Emergence of hippocampal avoidance cranial irradiation and SRS in SCLC patients may supplant whole cranial irradiation as future standards of care. Incorporation of novel systemic therapies such as immunotherapies has changed the treatment paradigm and overall outlook of patients with SCLC. This narrative review summarizes the current state, ongoing trials, and future directions of radiotherapy in management of SCLC.https://www.frontiersin.org/article/10.3389/fonc.2020.01146/fullsmall cell lung cancer (SCLC)Radiotherapy—Chemotherapyreview (article)immunotherapystereotactic ablative body radiationradiotherapy—adverse effects |
| spellingShingle | Michael C. Tjong David Y. Mak Jeevin Shahi George J. Li Hanbo Chen Alexander V. Louie Current Management and Progress in Radiotherapy for Small Cell Lung Cancer Frontiers in Oncology small cell lung cancer (SCLC) Radiotherapy—Chemotherapy review (article) immunotherapy stereotactic ablative body radiation radiotherapy—adverse effects |
| title | Current Management and Progress in Radiotherapy for Small Cell Lung Cancer |
| title_full | Current Management and Progress in Radiotherapy for Small Cell Lung Cancer |
| title_fullStr | Current Management and Progress in Radiotherapy for Small Cell Lung Cancer |
| title_full_unstemmed | Current Management and Progress in Radiotherapy for Small Cell Lung Cancer |
| title_short | Current Management and Progress in Radiotherapy for Small Cell Lung Cancer |
| title_sort | current management and progress in radiotherapy for small cell lung cancer |
| topic | small cell lung cancer (SCLC) Radiotherapy—Chemotherapy review (article) immunotherapy stereotactic ablative body radiation radiotherapy—adverse effects |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.01146/full |
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