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Radiother Oncol. 2019 Mar 15;135:74-77. doi: 10.1016/j.radonc.2019.02.010. [Epub ahead of print]

Consolidative thoracic radiotherapy in stage IV small cell lung cancer: Selection of patients amongst European IASLC and ESTRO experts.

Author information

1
Department of Radiation Oncology, St. Gallen, Switzerland; Department of Radiation Oncology, Bern, Switzerland. Electronic address: paul.putora@kssg.ch.
2
Department of Radiation Oncology, St. Gallen, Switzerland.
3
Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands.
4
Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, UK.
5
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
6
Institut Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France.
7
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Medical Oncology, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
8
Director Oncology and Hematology Department, AUSL Romagna, Ravenna, Italy.
9
Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
10
Department of Oncology and Radiotherapy, Gdansk, Poland.
11
Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain.
12
Department of Medical Oncology/Hematology, St. Gallen, Switzerland; University of Bern, Switzerland.
13
Hospital Universitario Ramón y Cajal, Madrid, Spain.
14
Comité Pathologie Thoracique, Comité Sarcomes et Tumeurs Mesenchymateuses Gustave Roussy, France.
15
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
16
Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany.
17
Oncology Department, AOU San Luigi, University of Turin, Italy.
18
Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, UK.
19
Hospital Universitario 12 de Octubre, Madrid, Spain.
20
Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany.
21
Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
22
LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany.
23
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
24
Department Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium.
25
CHU de Besançon, Besançon, France.
26
Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Austria.
27
Service de radiothérapie, CHU Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France.
28
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

The role of consolidative thoracic radiotherapy (TRT) in stage IV small cell lung cancer (SCLC) is not uniformly accepted.

METHODS:

We obtained a list of 13 European medical oncologists from the International Association for the Study of Lung Cancer (IASLC) and 13 European radiation oncologists from the European Society for Therapeutic Radiation Oncology (ESTRO). The strategies in decision making for TRT in stage IV SCLC were collected. Decision trees were created representing these strategies. Frequencies of recommending TRT were analysed for various parameter combinations based on the objective consensus methodology.

RESULTS:

The factors associated with the recommendation for TRT included fitness of the patient, limited extrathoracic tumour burden, initial bulky thoracic disease and response to chemotherapy. The highest consensus for TRT was in fit patients with limited extrathoracic tumour burden and initial bulky disease with either a complete extrathoracic response or partial thoracic response (92% recommend TRT). For these patients the recommendations were the same for medical and radiation oncologists. In the setting of partial response (intra- and extra-thoracically) without initial bulky thoracic disease radiation oncologists were more likely to recommend TRT than medical oncologists. For unfit patients or for patients with poor overall response to chemotherapy, the majority did not recommend TRT.

CONCLUSION:

European radiation and medical oncologists specializing in lung cancer recommend TRT in selected patients with stage IV SCLC and restrict its use primarily to fit patients who responded to chemotherapy with limited extrathoracic tumour burden.

KEYWORDS:

ESTRO; Expert opinion; IASLC; Small cell lung cancer; Stage IV; Thoracic radiotherapy

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