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ES04 - Multimodality Management of Small Cell and Neuroendocrine Cancers (ID 7)
- Event: WCLC 2019
- Type: Educational Session
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
ES04.04 - Role of Stereotactic Body Radiation in Early and Advanced SCLC (Now Available) (ID 3171)
10:30 - 12:00 | Presenting Author(s): Roy Decker
Stereotactic Body Radiotherapy (SBRT) has been rapidly adopted as the standard of care for patients with early-stage Non-Small Cell Lung Cancer (NSCLC) who are medically inoperable, and more recently for selected patients with oligometastatic cancer. The utilization of SBRT in patients with Small Cell Lung Cancer (SCLC) is markedly lower, reflecting both the lower incidence and the lack of clinical data, but it has been increasing over the past several years. Given the aggressive nature and high metastatic potential of SCLC, the optimal integration of SBRT into the multimodality treatment of early-stage SCLC patients is critical, so that we don’t delay or otherwise compromise systemic therapy. In patients with advanced or recurrent SCLC, SBRT offers a valuable treatment option for well selected patients, a group that may be increasing as new therapeutic options emerge.
Small Cell Lung Cancer (SCLC) represents less than 20% of all new lung cancer diagnoses. Compared to NSCLC, SCLC is less likely to present with localized disease, carries a higher risk of metastatic failure, and stage for stage is associated with worse overall survival. The majority of limited stage SCLC patients have locally advanced tumors, and the standard of care remains concurrent chemotherapy with fractionated thoracic radiation. Stage I SCLC is diagnosed in less than 5% of incident cases. Given the propensity for nodal metastasis, invasive staging of the mediastinum is indicated in all of these patients. For those who are node negative, there is a limited amount of data to guide decisions about optimal management. Surgery has emerged as a standard of care for operable patients, based on favorable outcomes in population-based studies. Following surgery, adjuvant chemotherapy is recommended regardless of tumor size, based on the high risk of subsequent metastatic failure.
For those patients who won’t tolerate lobectomy, consensus guidelines now recognize that Stereotactic Body Radiotherapy (SBRT) is a treatment option, and a reasonable alternative to conventional chemoradiotherapy. This is largely justified by the observed increased efficacy of SBRT compared to fractionated radiation in stage I NSCLC, an observation which is now supported by a randomized trial. The published data to date suggests that the utilization of SBRT in stage I SCLC has been increasing. Single- and multi-institutional case series suggest, unsurprisingly, that this approach appears to be safe, and the efficacy in terms of local control appears to be similar to that seen in NSCLC patients. In the US, the use of SBRT in SCLC appears to be more common in elderly patients, and the utilization seems to be driven by large institutions.
Chemotherapy is an essential part of multimodality care of SCLC in all stages of disease. The addition of adjuvant chemotherapy sequentially after SBRT in early stage patients is associated with improved survival in retrospective studies, similar to the better outcomes seen with surgery and chemotherapy in operable SCLC patients. Recent and ongoing prospective efforts are evaluating concurrent chemotherapy with SBRT, including both traditional short-course and more extended hypo-fractionated radiation schedules.
Trends in stereotactic body radiation therapy for stage I small cell lung cancer. Stahl JM, Corso CD, Verma V, Park HS, Nath SK, Husain ZA, Simone CB 2nd, Kim AW, Decker RH. Lung Cancer. 2017 Jan;103:11-16.
Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer. Verma V, Simone CB 2nd, Allen PK, Gajjar SR, Shah C, Zhen W, Harkenrider MM, Hallemeier CL, Jabbour SK, Matthiesen CL, Braunstein SE, Lee P, Dilling TJ, Allen BG, Nichols EM, Attia A, Zeng J, Biswas T, Paximadis P, Wang F, Walker JM, Stahl JM, Daly ME, Decker RH, Hales RK, Willers H, Videtic GM, Mehta MP, Lin SH. Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):362-371.
Clinical Outcomes of Stereotactic Body Radiotherapy for Patients With Stage I Small-Cell Lung Cancer: Analysis of a Subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group Database. Shioyama Y, Onishi H, Takayama K, Matsuo Y, Takeda A, Yamashita H, Miyakawa A, Murakami N, Aoki M, Matsushita H, Matsumoto Y, Shibamoto Y; Japanese Radiological Society Multi-Institutional SBRT Study Group (JRS-SBRTSG). Technol Cancer Res Treat. 2018 Jan 1;17:1533033818783904.
Stereotactic body radiotherapy with concurrent chemotherapy extends survival of patients with limited stage small cell lung cancer: a single-center prospective phase II study. Li C, Xiong Y, Zhou Z, Peng Y, Huang H, Xu M, Kang H, Peng B, Wang D, Yang X. Med Oncol. 2014 Dec;31(12):369.
Outcomes of Stereotactic Body Radiotherapy for T1-T2N0 Small Cell Carcinoma According to Addition of Chemotherapy and Prophylactic Cranial Irradiation: A Multicenter Analysis. Verma V, Simone CB 2nd, Allen PK, Lin SH. Clin Lung Cancer. 2017 Nov;18(6):675-681.e1.
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