Follow-up/Toxicity

Question 1

What is the recommended f/u schedule for SCLC pts?

Answer 1

SCLC f/u schedule: H&P, CT chest/liver/adrenal, and labs at each visit (visits q3–4mos for yrs 1–2, q6mos for yrs 3–5, then annually). PET scan should be considered whenever CT findings suggest recurrence or mets.

Question 2

What is the total lung V20 dose–volume constraint for RT alone and concurrent CRT in definitive lung cancer Tx?

Answer 2

RT alone: V20 <40%

CRT: V20 <35%

Question 3

What is the recommended MLD constraint with definitive RT for lung cancer?

Answer 3

MLD is <15 Gy ideally but not >20 Gy.

Question 4

What is the max cord dose allowed on INT-0096 (“Turrisi regimen”)?

Answer 4

On INT-0096, the max cord dose was 36 Gy (but max dose is 41 Gy in ongoing CALGB 30610 trial).

Question 5

What is the main toxicity associated with using bid RT as done in the Turrisi regimen?

Answer 5

Grade 3–4 acute esophagitis: 27% (bid) vs. 11% (qd). Other toxicities (myelosuppression, nausea) were the same as the qd regimen. This is much less in modern era using 3D or IMRT approaches, with no difference b/t QD vs. BID Tx per CONVERT trial (19% in both arms).

Question 6

What is the distinction b/t grade 2 and 3 pneumonitis (per the RTOG)?

Answer 6

Grade 3 pneumonitis: dyspnea at rest or oxygen supplementation needed

Grade 2 pneumonitis: symptomatic and not requiring oxygenation

Question 7

What is the heart dose–volume constraint for RT alone vs. concurrent CRT?

Answer 7

According to CALGB 30610, the following limits are also acceptable: 60 Gy less than one-third, 45 Gy less than two-thirds, and 45 Gy <100%.

Question 8

What is the esophageal dose–volume constraint for RT alone vs. concurrent CRT?

Answer 8

RT alone: V60 <50%

CRT: V55 <50% (ideally, keep the mean dose to <34 Gy per RTOG 0538)