Lung Flashcards
What is the gold standard for radiotherapy fractionation in Limited-Stage Small Cell Lung Cancer (LS-SCLC)?
Twice-daily (BID) 45 Gy in 30 fractions
This is based on the Turrisi trial.
What alternative radiotherapy regimen is considered valid for LS-SCLC?
Once-daily (OD) 60-66 Gy
This is supported by the CONVERT trial.
Which regimen is commonly used in real-world practice for LS-SCLC despite a lack of head-to-head randomized trials?
British Columbia regimen (40-42 Gy in 15 fractions)
This is frequently utilized despite the absence of direct comparisons.
What is the panel consensus on the ideal radiotherapy fractionation for LS-SCLC?
BD is ideal, but OD or hypofractionation (40/15) is often chosen based on patient preference and logistics.
What do Norwegian and Chinese trials suggest about dose escalation in LS-SCLC?
Higher BID doses (54 Gy in 30 or 60 Gy in 40 fractions) may improve survival.
What established the new standard of care for consolidation treatment in LS-SCLC?
Adriatic trial established consolidation durvalumab.
What concerns exist about combining radiation with immunotherapy in LS-SCLC?
Potential immunosuppressive effects of mediastinal RT.
What is the trend regarding Prophylactic Cranial Irradiation (PCI) in LS-SCLC?
Declining use despite being recommended in guidelines.
What are the reasons for the declining use of PCI in LS-SCLC?
- Neurotoxicity concerns with PCI
- Longer survival with modern systemic therapy
What does the LU005 trial indicate about use of PCI?
Even when PCI was strongly encouraged, 55% of patients did not receive it.
What is the conditional recommendation for Consolidation Thoracic RT in Extensive-Stage Small Cell Lung Cancer (ES-SCLC)?
30 Gy in 10 fractions for residual thoracic disease post chemo-immunotherapy.
Which trials are investigating concurrent/consolidation RT with immunotherapy in ES-SCLC?
- CHESS-RT
- LU007
What systemic therapy combination announced in 2023 improved PFS and OS in ES-SCLC?
Lurbinectedin + Atezolizumab
phase 3 IMforte trial, this combination was evaluated as a first-line maintenance therapy following induction treatment with carboplatin, etoposide, and atezolizumab. The study demonstrated a statistically significant improvement in both overall survival (OS) and progression-free survival (PFS) compared to atezolizumab alone.
What does the American Radium Society (ARS) recommend for treating brain metastases?
Whole-Brain RT (WBRT)
This recommendation is being challenged by new data.
What does new data from ASTRO 2023 indicate about SRS for brain metastases?
Randomized ENCEPHALON (ARO 2018-9) Trial, Phase 2
SRS (≤10 brain mets) leads to better cognitive outcomes without impacting survival.
Significant cognitive effect in 3 months for WBRT
What is the panel consensus on the preferred treatment for limited brain metastases?
SRS is now preferred over WBRT.
What is the emerging trend in managing radiation toxicity in the immunotherapy era?
SRS + DURVA shows no strong evidence for increased toxicity.
What are the future research priorities for SCLC treatment?
- Large registry studies and real-world data
- Addressing lack of preclinical research on radiation-immunotherapy interactions
- Biomarker-driven approaches
What is the future outlook on PCI in SCLC treatment?
PCI may be phased out in favor of MRI surveillance.
What is the conclusion about the evolution of SCLC treatment as presented in the session?
SCLC treatment is rapidly evolving, with RT strategies adapting to modern systemic therapies.
What does KEYNOTE 407 show?
For metastatic NSCLC SCC, addition of pembrolizumab to chemotherapy showed overall survival benefit in all levels of PD-L1 subgroups.
