Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
New York Proton Center, New York, New York.
J Thorac Oncol. 2021 Jan;16(1):54-65. doi: 10.1016/j.jtho.2020.09.013. Epub 2020 Oct 1.
The standard-of-care therapy for extensive-stage SCLC has recently changed with the results of two large randomized trials revealing improved survival with the addition of immunotherapy to first-line platinum or etoposide chemotherapy. This has led to a lack of clarity around the role of consolidative thoracic radiation and prophylactic cranial irradiation in the setting of chemoimmunotherapy.
The American Radium Society Appropriate Use Criteria are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with the application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for extensive-stage SCLC.
Current evidence supports either prophylactic cranial irradiation or surveillance with magnetic resonance imaging every 3 months for patients without evidence of brain metastases. Patients with brain metastases should receive whole-brain radiation with a recommended dose of 30 Gy in 10 fractions. Consolidative thoracic radiation can be considered in selected cases with the recommended dose ranging from 30 to 54 Gy; this recommendation was driven by expert opinion owing to the limited strength of evidence, as clinical trials addressing this question remain ongoing.
Radiation therapy remains an integral component in the treatment paradigm for ES-SCLC.
广泛期小细胞肺癌的标准治疗方法最近发生了变化，两项大型随机试验的结果表明，在一线铂类或依托泊苷化疗中加入免疫疗法可提高生存率。这导致在化疗免疫治疗中，关于巩固性胸部放疗和预防性脑照射的作用存在不确定性。
美国镭射学会适当使用标准是针对特定临床情况的循证指南，由多学科专家小组进行审查。该指南包括对现有证据的审查和分析，并应用共识方法（改良 Delphi 法）对小组推荐的广泛期小细胞肺癌治疗方法的适当性进行评分。
目前的证据支持对无脑转移证据的患者进行预防性颅脑照射或每 3 个月进行磁共振成像监测。有脑转移的患者应接受全脑放疗，推荐剂量为 30 Gy，分 10 次。在选定的情况下可以考虑进行巩固性胸部放疗，推荐剂量为 30 至 54 Gy；由于临床试验仍在进行中，这一建议主要是基于专家意见，因为针对这一问题的临床试验证据有限。
放射治疗仍然是广泛期小细胞肺癌治疗模式的一个组成部分。
