What is the optimal timing of thoracic radiotherapy in patients receiving chemotherapy for limited stage SCLC?

From Cancer Guidelines Wiki


Two meta-analyses confirm that the addition of thoracic radiotherapy to chemotherapy improves survival in fit patients with limited stage SCLC.[1][2] A number of subsequent meta-analyses have examined the question of radiotherapy timing in patients receiving chemotherapy for SCLC.[3][4][5][6][7][8][9][10][11][12] Although not entirely consistent, a survival benefit is demonstrated favouring the early initiation of thoracic radiotherapy - especially if analysis is limited to trials employing platinum-containing chemotherapy.

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Evidence summary and recommendations

Evidence summary Level References
In patients with limited stage small cell lung cancer receiving platinum-containing chemotherapy, the early administration of concurrent thoracic radiotherapy improves overall survival compared to the later initiation of radiotherapy.

Last reviewed November 2015

I [3], [6], [11], [5], [8], [10]
Evidence-based recommendationQuestion mark transparent.png Grade
Fit patients with limited stage small cell lung cancer should receive thoracic radiotherapy concurrently with the first cycle of chemotherapy or as soon as possible thereafter.

Last reviewed November 2015


Practice pointQuestion mark transparent.png

It is desirable not only to institute radiotherapy as soon as possible, but also to complete it as soon as possible, ideally within 30 days.
Last reviewed November 2015

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  1. Pignon JP, Arriagada R, Ihde DC, Johnson DH, Perry MC, Souhami RL, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992 Dec 3;327(23):1618-24 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1331787.
  2. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992 Jun;10(6):890-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1316951.
  3. 3.0 3.1 Fried DB, Morris DE, Poole C, Rosenman JG, Halle JS, Detterbeck FC, et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol 2004 Dec 1;22(23):4837-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15570087.
  4. Pijls-Johannesma MC, De Ruysscher D, Lambin P, Rutten I, Vansteenkiste JF. Early versus late chest radiotherapy for limited stage small cell lung cancer. Cochrane Database Syst Rev 2005 Jan 25;(1):CD004700 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15674960.
  5. 5.0 5.1 De Ruysscher D, Pijls-Johannesma M, Vansteenkiste J, Kester A, Rutten I, Lambin P. Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann Oncol 2006 Apr;17(4):543-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16344277.
  6. 6.0 6.1 Huncharek M, McGarry R. A meta-analysis of the timing of chest irradiation in the combined modality treatment of limited-stage small cell lung cancer. Oncologist 2004;9(6):665-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15561810.
  7. Pijls-Johannesma M, De Ruysscher D, Vansteenkiste J, Kester A, Rutten I, Lambin P. Timing of chest radiotherapy in patients with limited stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials. Cancer Treat Rev 2007 Aug;33(5):461-73 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17513057.
  8. 8.0 8.1 De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 2006 Mar 1;24(7):1057-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16505424.
  9. Samson DJ, Seidenfeld J, Simon GR, Turrisi AT 3rd, Bonnell C, Ziegler KM, et al. Evidence for management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007 Sep;132(3 Suppl):314S-323S Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17873177.
  10. 10.0 10.1 Seidenfeld J, Samson DJ, Bonnell CJ, Ziegler KM, Aronson N. Management of small cell lung cancer. Evid Rep Technol Assess (Full Rep) 2006 Jul;(143):1-154 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17764204.
  11. 11.0 11.1 Stuschke M, Pöttgen C. Localized small-cell lung cancer: which type of thoracic radiotherapy and which time schedule. Lung Cancer 2004 Aug;45 Suppl 2:S133-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15552793.
  12. Lu H, Fang L, Wang X, Cai J, Mao W. A meta-analysis of randomized controlled trials comparing early and late concurrent thoracic radiotherapy with etoposide and cisplatin/carboplatin chemotherapy for limited-disease small-cell lung cancer. Mol Clin Oncol 2014 Sep;2(5):805-810 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25054049.

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Further resources

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