NCCN Small Cell Lung Cancer Flashcards
Workup of SCLC found on biopsy?
What are the consequences of smoking on the workup?
Big workup for SCLC:
Path review.
CT CAP w/ contrast.
Brain MRI.
PET.
Smoking cessation.
If never smoker w/ extensive stage (Stage IV, or T3/4 w/ multiple nodules that cannot be radiated), get molecular profiling.
If SCLC has pleural effusion, what should be done?
Thoracentesis.
If inconclusive, do thoracoscopy.
A SCLC pt has T1-2 N0M0 clinical staging (PET, brain MRI, CT CAP), what’s next?
Assess for clinical surgical candidacy (PFTs and clinical exam) ->
Pathological mediastinal staging (no need if not surgical candidate).
This is a possible resection candidate.
Then check response to tx (CT CAP, brain MRI, CBC/CMP).
Then probably Darvalulmab if either stable or evidence of response to initial treatment.
Ppx cranial irradiation.
Surveillance: oncology, mostly to follow brain MRIs, surveillance CTs. Smoking cessation.
A pt w/ SCLC has PET equivocal for bone mets, what’s next (workup)?
Bone imaging via XR or MRI.
If still equivocal, get biopsy.
When should a pt w/ SCLC get bone MARROW biopsy?
Peripheral smear w/ nucleated RBCs, neutropenia, thrombocytopenia (suggest bone marrow infiltration)
A pt w/ early, small SCLC gets clinical staging (PET, brain MRI, CT CAP; and thoracentesis, bone imaging, bone biopsy, or marrow biopsy as needed), then gets mediastinal staging, which is negative. What’s next?
Lobectomy is preferred.
Mediastinal lymph node dissection or sampling.
A pt w/ SCLC gets clinical staging (PET, brain MRI, CT CAP; and thoracentesis, bone imaging, bone biopsy, or marrow biopsy as needed).
Mediastinal staging is negative.
Lobectomy w/ LN dissection/sampling done.
How does N status after resection change treatment?
N0 - systemic therapy (everyone gets systemic therapy)
N1/2 - systemic therapy and mediastinal RT
*if nodes are positive, add RT to mediastinum
What are options for medically inoperable T1-2 N0M0 (stage I-IIa) SCLC?
SABR then systemic therapy.
Systemic therapy and concurrent RT.
If a SCLC pt has limited stage IIB-IIIC (T3-4,N0,M0 or T1-4,N1-3,M0), what should be figured out next? What are treatment options?
Performance status AND if related to cancer:
Good is 0-2 -> systemic therapy AND concurrent RT.
Poor is 3-4 and from SCLC -> systemic therapy +/- either concurrent or sequential RT.
Poor (3-4) not from SCLC -> individualized treatment, including supportive care.
What is extensive stage SCLC? How is it managed?
Extensive stage: stage IV, T3-4 b/c of multiple lung nodules that are too extensive or tumor/nodal volume too large to be encompassed in a tolerable radiation plan.
Tx Principles:
- Systemic therapy for all. Can basically keep giving until no response, unacceptable toxicity, or performance score 3-4.
- RT to symptomatic sites (SVC, lung, bone, brain) before systemic therapy
For SCLC, what workup is needed after primary treatment (ie response assessment)?
CT CAP w/ contrast, brain MRI, labs
A pt w/ limited stage SCLC gets lobectomy, then systemic therapy. Treatment response assessment (CT CAP w/ contrast, brain MRI, labs) shows complete response.
What’s next?
What is limited stage?
Prophylactic cranial irradiation (PCI).
Limited stage: slinical I-IIa (T1-2,N0,M0).
What is surveillance for SCLC after tx?
Surveillance CT - chest +/- abd/pelvis x2-6 mo.
MRI brain
- New pulm nodule - workup for new primary
- PET is NOT recommended routinely
