Should consolidative RT for extensive stage SCLC be given before, after, or concurrently with PCI?
In the study published by Slotman et al (Lancet 2015), nearly all the patients in the thoracic RT arm started with PCI. For patients with gross disease in the chest (PR to chemo) and not the brain, does it make more sense to treat the chest first? Since total RT "package time" is only about 4-5 weeks, does sequence even matter?
Answer from: Radiation Oncologist at Academic Institution
Great question, and to my knowledge there's not a lot of data to guide this so I dont think there's a wrong answer.Before the CREST trial, my practice was to do PCI first, because I felt that the evidence for an OS benefit was much stronger, and it was therefore more improtant to get this completed ...
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Answer from: Radiation Oncologist at Academic Institution
In the extensive disease setting, I have been doing PCI and thoracic radiation concurrently if the patient wants both. But frequently once I present the controversy of PCI in the extensive disease setting, the patient chooses just to have thoracic radiation. I feel very ambivalent about ...
Answer from: Radiation Oncologist at Community Practice
For a change, I can agree with the above. CREST disappointed. It did *NOT* improve one year survival. TRT seemed to have no benefit in those that achieved a CR! I've not heard update on 2014 Japanese trial attemptong to undo the strong results Slotman published for PCI in SCLC. To me, the PCI da...
Answer from: Radiation Oncologist at Community Practice
If we offer PCI and thoracic RT we do it concurrently
Answer from: Radiation Oncologist at Academic Institution
We also tend to do concurrent PCI and thoracic RT in patients with good performance status.
Answer from: Radiation Oncologist at Community Practice
Are there any updates to the above question?
Comments
Radiation Oncologist at Quillen VA Medical Center
ASTRO guideline no longer embraces PCI for anyone ...
ASTRO guideline no longer embraces PCI for anyone ...