Thoracic radiotherapy in small cell lung cancer-a narrative review
Affiliation
Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France.Issue Date
2021
Metadata
Show full item recordAbstract
Small-cell lung cancer (SCLC) represents 10-15% of all lung cancers and has a poor prognosis. Thoracic radiotherapy plays a central role in current SCLC management. Concurrent chemoradiotherapy (CTRT) is the standard of care for localised disease (stage I-III, limited-stage, LS). Definitive thoracic radiotherapy may be offered in metastatic patients (stage IV, extensive stage, ES-SCLC) after chemotherapy. For LS-SCLC, the gold standard is early accelerated hyperfractionated twice-daily CTRT (4 cycles of cisplatin etoposide, starting with the first or second chemotherapy cycle). Modern radiation techniques should be used with involved-field radiotherapy based on baseline CT and PET/CT scans. In ES-SCLC, thoracic radiotherapy should be discussed in cases of initial bulky mediastinal disease/residual thoracic disease not progressing after induction chemotherapy. This strategy was however not assessed in recent trials establishing chemo-immunotherapy as the standard first line treatment in ES-SCLC. Future developments include technical radiotherapy advances and the incorporation of new drugs. Thoracic irradiation is delivered more precisely given technical developments (IMRT, image-guided radiotherapy, stereotactic radiotherapy), reducing the risks of severe adverse events. Stereotactic ablative radiotherapy may be discussed in rare early stage (T1 to 2, N0) inoperable patients. A number of current clinical trials are investigating immunoradiotherapy. In this review, we highlight the current role of thoracic radiotherapy and describe ongoing research in the integration of biological surrogate markers, advanced radiotherapy technologies and novel drugs in SCLC patients.Citation
Levy A, Botticella A, Le Péchoux C, Faivre-Finn C. Thoracic radiotherapy in small cell lung cancer—a narrative review. Transl Lung Cancer Res. 2021 Apr;10(4):2059–70.Journal
Translational Lung Cancer ResearchDOI
10.21037/tlcr-20-305PubMed ID
34012814Additional Links
https://dx.doi.org/10.21037/tlcr-20-305Type
OtherLanguage
enae974a485f413a2113503eed53cd6c53
10.21037/tlcr-20-305