SCLC

Question 1

What investigations should be performed in suspected lung SCLC?

Answer 1

Hx & examination
Bloods - incl LDH
CT TAP
Biopsy - bronchoscopy with EBUS
PET/CT
Brain MRI with contrast
Lung function tests of XRT/surgery considered

Question 2

What TNM stages are typically thought of as extensive?

Answer 2

M1 or not encompassable in XRT field

Question 3

What timescale should you aim to start treatment?

Answer 3

Within 2/52 of diagnosis

Question 4

What are the IHC features of SCLC?

Answer 4

CD56 + (90%)
Chromogranin
Synaptophysin
Napsin A -

Question 5

If Surgery is performed for a T1-2NOMO SCLC, what adjuvant therapy should be given?

Answer 5

Adjuvant chemotherapy

No role for adjuvant thoracic XRT unless R1-2 resection or unforseen N2 disease

OS 50% for R0 resection

Role of PCI uncertain in stage I

Question 6

Is there a role for SABR in the management of SCLC?

Answer 6

Yes in early stage disease with peripheral tumours (T1N0)

Question 7

What is the standard of care for pts with locally advanced SCLC who are PS 0-1?

Answer 7

Concurrent chemo radiation

Cisplatin 75mg/m2 and etoposide 100mg/m2 D1 x 4-6 cycles with XRT starting C2 D1

XRT 45Gy/30# BD x3/52

Alternative 66Gy/33#

If <75y and significant response PCI

Question 8

What is the dose of PCI following treatment for limited stage disease?

Answer 8

25Gy/10# over 2/52

Question 9

What is the mOS benefit of PCI in limited stage disease?

Answer 9

MOS 14.3m v 8.5m

Reduces risk of brain mets >50% and improves 3y OS from 15–>21%

Question 10

What is the 5y OS for pts with PS0-1 following tx with CRT?

Answer 10

30%

Question 11

What is the management strategy for pts with limited stage disease who are >75y or PS 2?

Answer 11

Sequential CRT

Carbo AUC5 & etoposide 100mg/m2 D1-3. X4cycles

Followed by (2-6/52 after):
55Gy in 20# over 4/52 and PCI 25Gy/10# over 2/52

Question 12

In the sequential setting, what tumour volumes should be treated in XRT?

Answer 12

Post chemotherapy primary tumour volume and pre-chemotherapy nodal volume

Question 13

What did the Slotman trial show?

Answer 13

Improved survival at 2y (13% v 3%) with pts with ES-SCLC receiving thoracic XRT following response to chemotherapy

Question 14

How would you tx a pt with good PS with metastatic disease?

Answer 14

Sequential chemoradiotherapy

Carbo AUC5 & etoposide 100mg/m2 D1, 200mg/m2 op d2&3. For max 6 cycles
With atezolizumab 1200mg IV D1 (continued for 2y)

If partial or complete response, consolidation XRT to thorax and PCI

Question 15

What dose of consolidation XRT and PCI is given in metastatic disease?

Answer 15

30Gy in 10# over 2/52 and 20Gy/5# PCI