Lung: Limited-stage SCLC thoracic RT

Question

A 59-year-old woman with limited-stage small-cell lung cancer (confined to one hemithorax, encompassable in a tolerable radiotherapy volume) has WHO performance status 0 and is due to start concurrent chemoradiotherapy with cisplatin-etoposide. What is the most appropriate thoracic radiotherapy schedule, and when should it start?

Accepted Answer

E) Twice-daily radiotherapy 45 Gy in 30 fractions, starting during the first or second cycle of chemotherapy — NICE NG122 recommends offering twice-daily radiotherapy with concurrent chemotherapy to people with limited-stage SCLC, starting the radiotherapy during the first or second cycle of chemotherapy. The CONVERT trial used 45 Gy in 30 twice-daily fractions starting on day 22 (cycle 1) and concluded that twice-daily radiotherapy should remain the standard of care, as once-daily was not shown to be superior.

Answer

A) Once-daily radiotherapy 66 Gy in 33 fractions, starting after completion of chemotherapy

Answer

B) Single-fraction palliative radiotherapy after two cycles of chemotherapy

Answer

C) SABR 54 Gy in three fractions concurrent with cycle 1

Answer

D) Twice-daily radiotherapy 45 Gy in 30 fractions, starting only if disease progresses on chemotherapy