Would you consider SBRT for an inoperable T1-T2 N0 SCLC?

The concept of using SBRT in the setting of inoperable early-stage node negative small cell lung cancer (SCLC) is interesting and replicates the concept of SBRT as a surgical surrogate. In other words, SBRT is used to manage the primary lesion, as with early-stage non-small cell lung cancer (NSCLC)....

The standard is surgical resection. As some are medically impaired, TRT options include SBRT, I know of no data or series. My practice has been 45 Gy/3wks. Also not evidence-based. Some of these nodules may sample just SCLC, but harbor carcinoid or NSCLC.

In resected, 4 Cycles Plat/Etop.

Low inciden...

As @Dr. First Last says, the concept of using SBRT as a surgical surrogate for early-stage SCLC is rational. We have not routinely done this at our center and for now, I'd still consider the standard of care (for inoperable patients) to be concurrent chemoradiation to 45Gy BID. Other data is likely ...

I have used both SBRT followed by platinum/etoposide, SBRT alone, and the hyperfractionated 4500 cGy with 150 cGy BID regimen with concurrent platinum/etoposide. This is not common for an SCLC presentation and patient preference and co-morbidities need to be considered in determining the appropriate...

For those seeking additional references to support SBRT (SABR) for stage I SCLC, a nice editorial/review by Drs. Verma, @Dr. First Last, and @Dr. First Last can be found at the Oncologist PMID 26764248, ahead of several additional publications by the same authors (PMID 28011047, PMID 28408183, PMID ...

No N-0 in Intergroup trial. One might pose this to CONVERT and recent Scandinavian trialists. Overview of surgically treated N-0 showed a low incidence of CNS failure.

The EQD and BEDs go up from 45 BID to 60 BID to 70 Gy to 50/5 SBRT. CALGB says 70 is as good as 45 BID at nearly 5 years.

For elderly, comorbid patients, and T1N0 patients, it seems like SBRT + chemo is reasonable. Is EBUS mandatory first or is a reasonable PET result sufficient (groans from the cr...