Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2021; 12(3): 115-143
Published online Mar 24, 2021. doi: 10.5306/wjco.v12.i3.115
GOECP/SEOR radiotherapy guidelines for small-cell lung cancer
Felipe Couñago, Carolina de la Pinta, Susana Gonzalo, Castalia Fernández, Piedad Almendros, Patricia Calvo, Begoña Taboada, Antonio Gómez-Caamaño, José Luis López Guerra, Marisa Chust, José Antonio González Ferreira, Ana Álvarez González, Francesc Casas
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Madrid, Spain
Carolina de la Pinta, Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
Susana Gonzalo, Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
Castalia Fernández, Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
Piedad Almendros, Department of Radiation Oncology, Hospital General Universitario, Valencia 46014, Spain
Patricia Calvo, Begoña Taboada, Antonio Gómez-Caamaño, Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
José Luis López Guerra, Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
Marisa Chust, Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
José Antonio González Ferreira, Department of Radiation Oncology, GenesisCare-Spain, Sevilla 41092, Spain
Ana Álvarez González, Department of Radiation Oncology, HGU Gregorio Marañón, Madrid 28007, Spain
Francesc Casas, Department of Radiation Oncology, Thoracic Unit, Hospital Clinic, Barcelona 08036, Spain
Author contributions: All the authors contributed equally to this work.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Felipe Couñago, PhD, Chief Physician, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, C/Diego de Velázquez, 2, Pozuelo de Alarcón, Madrid 28223, Madrid, Spain.
Received: December 14, 2020
Peer-review started: December 14, 2020
First decision: January 25, 2021
Revised: January 25, 2021
Accepted: February 12, 2021
Article in press: February 12, 2021
Published online: March 24, 2021

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.