American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020

• Published in: Journal of thoracic oncology Vol. 16; no. 1; pp. 66 - 75
• Main Authors: Chun, Stephen G., Simone, Charles B., Amini, Arya, Chetty, Indrin J., Donington, Jessica, Edelman, Martin J., Higgins, Kristin A., Kestin, Larry L., Movsas, Benjamin, Rodrigues, George B., Rosenzweig, Kenneth E., Slotman, Ben J., Rybkin, Igor I., Wolf, Andrea, Chang, Joe Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2021
• Subjects: ARS; AUC; Chemoradiotherapy; Cranial Irradiation; Humans; Limited-stage SCLC; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - radiotherapy; Radium - therapeutic use; Small Cell Lung Carcinoma - radiotherapy; United States; United States; Limited-stage SCLC; ARS; Lung cancer; AUC
• ISSN: 1556-0864; 1556-1380; 1556-1380
• DOI: 10.1016/j.jtho.2020.10.020

Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. The ARS AUC 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 application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1–directed immune therapy should not be routinely administered outside the context of clinical trials at this time. The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.