Topics:
Lung Cancer • Radiation Oncology • Thoracic Malignancies • Medical Oncology • Small cell lung cancer
As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?
Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction chemoimmunotherapy?
Answer from: Radiation Oncologist at Community 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...
Sign in or Register to read more
Answer from: Medical Oncologist at Academic Institution
The data supporting consolidation thoracic radiotherapy (cTRT) after chemotherapy response in ES-SCLC are relatively soft. The phase III Jeremic trial (JCO 17:2092, 1999) reported an overall survival (OS) improvement with accelerated hyperfractionated cTRT to 54 Gy + daily carboplatin/etoposide in a...
Comments
Radiation Oncologist at Mon Health
@Gregory P. Kalemkerian, This was very helpful! ...
@Gregory P. Kalemkerian, This was very helpful! ...
Radiation Oncologist at Northeast Alabama Regional Medical Center
"The more recent phase III Slotman trial (Lancet 3...
"The more recent phase III Slotman trial (Lancet 3...
Answer from: Medical Oncologist at Academic Institution
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...
Comments
Radiation Oncologist at Fort Bend Medical and Diagnostic Center
NRG LU007 allows 45 Gy in 15 fractions or 30 Gy in...
NRG LU007 allows 45 Gy in 15 fractions or 30 Gy in...
Answer from: Radiation Oncologist at Academic Institution
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...
Answer from: Medical Oncologist at Community Practice
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 ...