GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

Abstract

Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.

Keywords: Small cell lung cancer, Chemotherapy, Hyperfractionated radiation therapy, Prophylactic brain irradiation, Brain metastases, Reirradiation

Core Tip: Small cell lung cancer is the paradigmatic model of multidisciplinary cancer treatment. The improvement in overall survival over the last 70 years is primarily due to combined therapies and close collaboration among specialists to administer local and systemic therapies. This cooperation has enabled clinicians to achieve an additive effect by combining chemotherapy and radiotherapy while ensuring that the overall toxicity is manageable. The present review describes the evolution of the treatment of small cell lung cancer in recent decades as well as continuing advances in the multimodal therapeutic management of this disease.