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Topics:
Lung Cancer • Radiation Oncology • Thoracic Malignancies • Medical Oncology • Non-small cell lung cancer • Small cell lung cancer
How do you approach patients with stage III unresectable, combined histology NSCLC/SCLC?
What systemic therapy do you utilize? Which thoracic RT dose paradigm do you follow? Specifically, would you treat according to limited-stage SCLC standards (e.g., 45 Gy in 30 fractions BID), or favor a once-daily higher dose (e.g., 60 Gy) to address the NSCLC component?
Answer from: Radiation Oncologist at Academic Institution
For stage III lung cancer with mixed NSCLC and small-cell lung cancer, we treat patients with concurrent chemotherapy (cisplatin/etoposide every three weeks) and definitive radiotherapy (60-66 Gy in 30 fractions, QD), followed by adjuvant immunotherapy (durvalumab). The rationales are as follows:
R...
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Answer from: Medical Oncologist at Academic Institution
This is a difficult question and I am not sure there is a "right answer". I would probably discuss with my pathologist what seems to be the more dominant histology if there is one. I would choose cisplatin with etoposide rather than carboplatin with paclitaxel as the chemotherapy backbone due to the...