Figures
- Figure 1
Radiotherapy target volumes. Blue line: macroscopic disease (GTV); green line: GTV with motion (iGTV); light green: microscopic extension (CTV); red line: the final target volume (PTV).
- Figure 2
Sample radiation plan. The red line indicates the PTV; red coloured areas are the areas receiving the prescribed radiation dose; green and blue coloured areas receive a lower radiation dose.
- Figure 3
Prophylactic cranial irradiation. a) Stretching a heated mask over the patient; when the mask gets cold it becomes rigid. b) Radiation plan for whole-brain radiotherapy, the radiation field encompassing at least 95% of the prescribed radiation dose is shown in green.
Tables
- Table 1
Selected trials with hyper-fractionated regimes
Author, year [ref.] Design Patients n Chemotherapy Radiation dose/fractionation Results Oesophagitis grade 3–4 p-value# p-value# Turrisi, 1999 [26] Phase III 417 EP 45 Gy/1.5 Gy twice daily Median OS 23 months, 5-year OS 26% 0.04 27% <0.001 45 Gy/1.8 Gy once daily Median OS 19 months, 5-year OS 16% 11% Schild, 2004 [22] Phase III 261 EP 50.4 Gy/1.8 Gy once daily Median OS 20.6 months, 5-year OS 21% 0.68 5% 0.05 48 Gy/1.5 Gy twice daily (with a 2.5 week break inbetween) Median OS 20.6 months, 5-year OS 22% 12% Komaki, 2012 [27] Phase II 71 EP 39.6 Gy/1.8 Gy once daily followed by 21.6 Gy/1.8 Gy Median OS 19 months, 2-year OS 36.6% N/A 18% N/A Gronberg, 2016 [28] Phase II 157 EP 42 Gy/2.8 Gy once daily Median OS 18.8 months 0.61 31% 0.80 45 Gy/1.5 Gy twice daily Median OS 25.1 months 33% Faivre-Finn, 2016 [29] Phase III 547 EP 66 Gy/2 Gy once daily Median OS 25 months, 2-year OS 51% 0.15 19% No statistical difference 45 Gy/1.5 Gy twice daily Median OS 30 months, 2-year OS 56% 19% EP: etoposide and cisplatin-based chemotherapy; OS: overall survival. #: statistical significance p≤0.05.
- Table 2
Indications for radiotherapy in SCLC
Stage Indications to be discussed Very early Primary curative radiochemotherapy
Post-operative mediastinal radiotherapy (for N+ or R1)
Prophylactic cranial irradiationLocally advanced Primary curative radiochemotherapy
Prophylactic cranial irradiationExtensive disease (metastatic) Prophylactic cranial irradiation
Consolidative mediastinal radiotherapy
Palliative radiotherapy (including whole brain radiotherapy)
