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The role of radiation therapy in the management of small cell lung cancer

Markus Glatzer, Sabine Schmid, Marco Radovic, Martin Früh, Paul Martin Putora
Breathe 2017 13: e87-e94; DOI: 10.1183/20734735.009617
Markus Glatzer
1Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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  • For correspondence: markus.glatzer@kssg.ch
Sabine Schmid
2Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Marco Radovic
1Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Martin Früh
2Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Paul Martin Putora
1Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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  • Figure 1
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    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).

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    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.

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    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

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  • Table 1

    Selected trials with hyper-fractionated regimes

    Author, year [ref.]DesignPatients nChemotherapyRadiation dose/fractionationResultsOesophagitis 
grade 3–4
    p-value#p-value#
    Turrisi, 1999 [26]Phase III417EP45 Gy/1.5 Gy twice dailyMedian OS 23 months, 5-year OS 26%0.0427%<0.001
    45 Gy/1.8 Gy once dailyMedian OS 19 months, 5-year OS 16%11%
    Schild, 2004 [22]Phase III261EP50.4 Gy/1.8 Gy once dailyMedian OS 20.6 months, 5-year OS 21%0.685%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 II71EP39.6 Gy/1.8 Gy once daily followed by 21.6 Gy/1.8 GyMedian OS 19 months, 2-year OS 36.6%N/A18%N/A
    Gronberg, 2016 [28]Phase II157EP42 Gy/2.8 Gy once dailyMedian OS 18.8 months0.6131%0.80
    45 Gy/1.5 Gy twice dailyMedian OS 25.1 months33%
    Faivre-Finn, 2016 [29]Phase III547EP66 Gy/2 Gy once dailyMedian OS 25 months, 2-year OS 51%0.1519%No statistical difference
    45 Gy/1.5 Gy twice dailyMedian 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

      StageIndications to be discussed
      Very earlyPrimary curative radiochemotherapy
      Post-operative mediastinal radiotherapy (for N+ or R1)
      Prophylactic cranial irradiation
      Locally advancedPrimary curative radiochemotherapy
      Prophylactic cranial irradiation
      Extensive disease (metastatic)Prophylactic cranial irradiation
      Consolidative mediastinal radiotherapy
      Palliative radiotherapy (including whole brain radiotherapy)
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    The role of radiation therapy in the management of small cell lung cancer
    Markus Glatzer, Sabine Schmid, Marco Radovic, Martin Früh, Paul Martin Putora
    Breathe Dec 2017, 13 (4) e87-e94; DOI: 10.1183/20734735.009617

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    The role of radiation therapy in the management of small cell lung cancer
    Markus Glatzer, Sabine Schmid, Marco Radovic, Martin Früh, Paul Martin Putora
    Breathe Dec 2017, 13 (4) e87-e94; DOI: 10.1183/20734735.009617
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    • Article
      • Abstract
      • Abstract
      • Standard of care for LD-SCLC
      • Post-operative radiation therapy for LD-SCLC
      • Radiation therapy for ED-SCLC
      • Other indications for radiation therapy in the management of SCLC
      • Summary
      • Footnotes
      • References
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    Subjects

    • Lung cancer
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