As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?

There are two trials showing benefit for TRT for patients with ES-SCLC, one from Yugoslavia and one from the EORTC (though, the primary endpoint was not met). The Yugoslavian trial was not considered practice changing, while the EORTC study has made me consider adding TRT in certain patients, even w...

The data supporting consolidation thoracic radiotherapy (cTRT) after chemotherapy response in ES-SCLC are relatively soft. The phase III Jeremic trial (Jeremic et al., PMID 10561263) reported an overall survival (OS) improvement with accelerated hyperfractionated cTRT to 54 Gy + daily carboplatin/et...

Welsh JTO 2020 published their prospective 45-patient phase I/II trial of carbo vp thoracic xrt with concurrent pembrolizumab. In this trial, the rate of pneumonitis was acceptable at 15% and there were no grade 5 toxicities. With this publication and that there are several concurrent immune checkpo...

Realizing that we do not have level I evidence to recommend thoracic radiation in extensive stage small cell lung cancer patients who are receiving/have received atezolizumab, I would still offer simple consolidative thoracic RT to a dose of 30 Gy in 10 fractions. I would offer it to those who had i...

In my experience, there is a small percentage of extensive stage SCLC patients who live several years, respond repeatedly to carbo/etoposide+/-checkpoint inhibitor who benefit from thoracic XRT. Restaging PET's show progression in the chest but previously PET(+) areas in bone/liver are gone. I tend ...