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6IN SCLC CONSENSUS
Lung Cancer 71 Suppl. 2 (2011) S5 Contents lists available at ScienceDirect
Lung Cancer journal homepage: www.elsevier.com/locate/lungcan
The Lugano Consensus on SCLC 6IN SCLC CONSENSUS 1
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C. Le Pechoux , P.E. Postmus , M. Fr¨ uh , J.B. Sorensen , N. Thatcher5 1 Department of Radiotherapy, Institute Gustave Roussy, Villejuif, France, 2 Pulmonary Diseases 4a50, VU University Medical Center, Amsterdam, Netherlands, 3 Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland, 4 Department of Thoracic Oncology, National University Hospital, Copenhagen, Denmark, 5 Medical Oncology Department, Christie Hospital NHS Trust, Manchester, United Kingdom Staging for SCLC should be done according to the TNM-system as of NSCLC and the old classification of LD and ED should be abandoned. The use of PET has not adequately been evaluated and should therefore not be recommended in the staging. If PET abnormalities are found, this should be confirmed by pathology. If on a single lesion, no pathological proof can be obtained, clinical behavior during chemotherapy may serve as a surrogate for pathology. For bone lesions in this situation, MRI should be used to confirm metastases. After a negative mediastinal exploration, surgical candidates should receive post-operative chemotherapy
0169-5002/$
see front matter © 2011 Elsevier Ireland Ltd.
and also radiotherapy to the mediastinum in case of N1 or etoposide remains the unforeseen N2 involvement. Platinum standard chemotherapy; for those with metastatic disease (M1), irinotecan might be used instead of etoposide. As concomitant thoracic radiotherapy is part of first-line therapy for M0 patients, 3D conformal radiotherapy is recommended and normal tissue constraints recorded. As target volume may be large, a V20 of 35 40% and a mean lung dose of 20 23 Gy should be accepted. Whether M1 patients will benefit from chest radiotherapy is under investigation. PCI is recommended for all patients with treatment induced tumor reduction, although for elderly patients the risk of neurocognitive damage should be taken into account. Regular follow-up is recommended after first-line therapy as secondline treatment is beneficial and easier in good PS patients. For those who are progressive during, or relapse early (<3 months) after first-line therapy, no specific therapy is available. For later relapse or progression, retreatment with first-line therapy or topotecan should be considered. For symptomatic patients palliative radiotherapy of the primary tumor might give temporarily relief of symptoms. Disclosure: All authors have declared no conflicts of interest.
Lung Cancer journal homepage: www.elsevier.com/locate/lungcan
The Lugano Consensus on SCLC 6IN SCLC CONSENSUS 1
2
3
4
C. Le Pechoux , P.E. Postmus , M. Fr¨ uh , J.B. Sorensen , N. Thatcher5 1 Department of Radiotherapy, Institute Gustave Roussy, Villejuif, France, 2 Pulmonary Diseases 4a50, VU University Medical Center, Amsterdam, Netherlands, 3 Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland, 4 Department of Thoracic Oncology, National University Hospital, Copenhagen, Denmark, 5 Medical Oncology Department, Christie Hospital NHS Trust, Manchester, United Kingdom Staging for SCLC should be done according to the TNM-system as of NSCLC and the old classification of LD and ED should be abandoned. The use of PET has not adequately been evaluated and should therefore not be recommended in the staging. If PET abnormalities are found, this should be confirmed by pathology. If on a single lesion, no pathological proof can be obtained, clinical behavior during chemotherapy may serve as a surrogate for pathology. For bone lesions in this situation, MRI should be used to confirm metastases. After a negative mediastinal exploration, surgical candidates should receive post-operative chemotherapy
0169-5002/$
see front matter © 2011 Elsevier Ireland Ltd.
and also radiotherapy to the mediastinum in case of N1 or etoposide remains the unforeseen N2 involvement. Platinum standard chemotherapy; for those with metastatic disease (M1), irinotecan might be used instead of etoposide. As concomitant thoracic radiotherapy is part of first-line therapy for M0 patients, 3D conformal radiotherapy is recommended and normal tissue constraints recorded. As target volume may be large, a V20 of 35 40% and a mean lung dose of 20 23 Gy should be accepted. Whether M1 patients will benefit from chest radiotherapy is under investigation. PCI is recommended for all patients with treatment induced tumor reduction, although for elderly patients the risk of neurocognitive damage should be taken into account. Regular follow-up is recommended after first-line therapy as secondline treatment is beneficial and easier in good PS patients. For those who are progressive during, or relapse early (<3 months) after first-line therapy, no specific therapy is available. For later relapse or progression, retreatment with first-line therapy or topotecan should be considered. For symptomatic patients palliative radiotherapy of the primary tumor might give temporarily relief of symptoms. Disclosure: All authors have declared no conflicts of interest.