Is it acceptable to use once daily fractionation for small cell lung cancer?
This question is still very relevant of further discussion. This particular poll and commentary began in June 2016! For the record, as of today I still prefer 45 Gy in 30 fractions delivered BID. For those that cannot come to treatment twice-daily, I use 60-66 Gy in 30-33 fractions based on OAR cons...
It is no accident that both the RTOG/CALGB and CONVERT, the latter completed in the summer 2013, used 45 gy BID in 3 wks as the control arm. Nothing else has proven better. @Dr. First Last discloses some information of an NCIC study using 40 gy close to the Canadian HypoFx for breast, used in SCLC i...
Another alternative would be 40 Gy in 15 fx per NCIC and London Lung Cancer Group studies. A recent randomized trial should be published soon demonstrating no difference between 45/30 bid and 40/15 qd in terms of survival. This hypofractionated course has not been compared to the phase I/II CALGB da...
Indeed I have seen the slides [CONVERT trial, presented at ASCO 2016] and while not published, cycle 2 plat/etop concurrent with 45 Gy bid in 30 fractions over 3 weeks and 66 Gy QD in 33 treatment days in 6 + weeks have similar survival, same local control, and similar esophagitis. However, the tria...
I routinely treat small cell lung cancer with QD fractionation (2Gy x 30) with concurrent chemotherapy. I work in a "safety net" hospital where most of the patients rely on volunteers or other public service to get to/from the hospital for treatments. When I started working here, I though BID would ...
Although it is entirely anecdotal, in my practice I have yet to see a 5 year survivor treated with once daily fractionation for curable SCLC. The only survivors have been treated with BID fractionation to 45 Gy. I keep the patients in the clinic if they have travel challenges, feeding them, etc. I u...