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Small Cell Lung Cancer > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

Dose limit to spinal cord?

A

37 Gy to Dmax with BID

45 Gy Dmax with QD

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2
Q

What are the RT dosing options for patients with limited stage disease?

A
  1. 45 Gy at 1.5 Gy/fx (30) BID

2. 66 Gy at 2 Gy/fx (33) QD

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3
Q

What imaging is needed for patients with small cell lung cancer?

A
  1. PET/CT scan
  2. MR brain
  3. Consider BM bx
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4
Q

What special studies are needed for patients with small cell lung cancer?

A
  1. PFTs
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5
Q

Follow up

A

H&P and Chest CT every 3 months for 2 years, then every 6 for year 3 years, then yearly.

CBC and CMP at each visit

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6
Q

Acute complications of RT

A

Esophagitis
Dermatitis
Cough
Fatigue

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7
Q

Subacute toxicities of RT

A

Radiation pneumonitis

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8
Q

Late complications of RT

A 
Esophogeal stricture or perforation 
Pericarditis 
CAD
Lhermittes syndrome 
Brachial plexopathy 
Rib fracture
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9
Q

Lung dose constraints?

A

V20 < 30%

MLD < 15 Gy

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10
Q

Esophagus dose constraints?

A

Mean dose < 34 Gy

V55:50%

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11
Q

Brachial plexus constraint?

A

Dmax 60 Gy

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12
Q

Heart constraint?

A

V40<40%

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13
Q

What is the dose for PCI?

A

25 at 2.5 Gy/fx

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14
Q

How to develop target volumes?

A

GTV = Gross tumor seen on CT planning scan

CTV= GTV + 1.5 cm margin including any initially involved nodal regions

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15
Q

Among patients with limited stage disease, who should get PCI?

A

All patients with CR or near CR, who have no sign of brain metastases.

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16
Q

What is the recommended treatment for patients with limited stage small cell lung cancer?

A

cT1-2 N0, medically operable
Lobectomy with mediastinal node sampling followed by adjuvant EP

cT3-4, N+, or medically inoperable
Cisplatin and etoposide every 3 weeks x 4 cycles.

Start RT during cycle 1 or 2 to the thorax.

Treatment with PCI for all patients who achieve either a CR or near CR.

17
Q

What is the median OS for patients with limited stage SCLC? 5 year OS?

A

MS: 20 months

5 year OS: 20-26%

18
Q

What is the median OS for patients with extensive stage SCLC?

A

12 months

5 year OS: <5%

19
Q

What is extensive stage disease?

A

Any disease not meeting limited stage

20
Q

What is limited stage disease?

A

Disease confined to to one hemithorax and regional nodes

21
Q

How is a tissue diagnosis made?

A

Sputum cytology
Bronchoscopy with EBUS and FNA transbronchial biopsy of tumor and suspicious nodes

CT guided biopsy is reserved for peripheral lesions

BM BX if LDH is elevated and clinically appears to be limited stage

22
Q

What counseling needs to be done at work up?

A

Smoking cessation counseling

23
Q

What is the most important prognostic factors?

A

Staging and performance status

24
Q

How to treat extensive stage in patients without brain metastases?

A
  1. Cisplatin and etoposide x 3 cycles s
  2. Reimage with CT scan of C/A/P, MR brain
  3. If CR peripherally, and atleast PR in the thorax, chest RT with concurrent cisplatin and etoposide. 54 Gy at 1.5 BID.
  4. Deliver PCI for all patients who have not progressed and have had atleast a PR.
25
Q

What histologic features are present with small cell lung cancer?

A

Small round blue cells
Neuroendocrine differentiation
Increased mitotic count
Increased N/C ratio

26
Q

What markers are commonly present with small cell lung cancer?

A 
S100+
Synaptophysin+ 
Chromagranin+ 
Neurotensin+
EGFR-
27
Q

What percentage of patients present with brain metastases?

A

10-15%

28
Q

What percentage of patients eventually develop brain metastases?

A

50-80%

29
Q

What did the pignon metaanalysis indicate about the benefit of RT to chemo?

A

5% improvement in OS

25-30% improvement in LC

30
Q

What is grade 2 pneumonitis?

A

Symptomatic but not requiring oxygen

31
Q

What is grade 3 pneumonitis?

A

Dyspnea at rest or oyxogen needed

32
Q

What study indicated that PCI can benefit patients with extensive stage disease after chemo?

A

EORTC 08993

33
Q

What study indicated that consolidative RT to the thorax improves OS for patients with extensive stage disease?

A

Jeremic et al

34
Q

What study supported BID thoracic RT?

A

INT 0096

35
Q

What labs are needed at work up?

A

CBC, CMP, LDH

36
Q

What chemotherapy doses for limited stage?

A
  1. Cisplatin 60 mg/m2 day 1
  2. Etoposide 120 mg/m2 days 1,2,3

Every 21 days, for 4-6 cycles

37
Q

What chemotherapy doses for extensive stage?

A
  1. Cisplatin 80 mg/m2 day 1
  2. Etoposide 80 mg/m2 days 1,2,3

Every 21 days, for 4-6 cycles

Small Cell Lung Cancer (1 decks)

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