Scottish Cancer Network: Clinical Management Pathways
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Indications |
‘Limited Stage’ = Any T, any N, M0 encompassable within radical volume |
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Performance status |
0-1 Consider PS2 if expected to improve after first cycle chemo Requires renal function sufficient for platinum (see SACT protocol) |
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Pulmonary function |
‘Adequate’ function allowing for anticipated improvement after first cycle |
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Dose and timing |
45Gy/30 treating bd over 3 weeks 40.05Gy/15/3w 66Gy/33/6.5w Timing of radiotherapy is to start as soon as possible after cycle 1 Day 1 |
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Chemotherapy (see SACT pathway and local SACT protocols for administration and dosing details) |
Cisplatin 80mg/m2+etoposide combination q3weeks 4 cycles total |
Small cell lung cancer
This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of these guidelines, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.
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Indications |
Consider sequential if patient deemed unable to cope with concurrent for fitness/logistical reasons, tumour volume deemed unsuitable for concurrent or anticipated toxicity risks excessive with concurrent |
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Performance status |
0-2 |
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Dose and timing |
Radiotherapy after cycle 4 in responding patients. Aim to start within 4 weeks of last chemo Can consider starting radiotherapy with C3 or C4 if responding early 40.05Gy/15/3w 55 Gy/20/4w |
If incomplete response to chemotherapy may consider higher dose radiation 50-55Gy/20.
If poor response to chemotherapy may consider 30Gy/10 to improve local control.
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Indications |
‘Extensive’ stage SCLC =Any T, any N, M1 or M0 and volume within one hemithorax but across midline or too large for primary radiotherapy treatment.
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Performance status |
0-3 |
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Dose |
30Gy/10/2w higher dose option/consolidation post chemo |
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Indications |
PCI can be considered if there has been a response to chemotherapy Consider PCI for PS0-1 and age <70 but may be considered in exceptional cases age 70-75 or good PS2 |
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Performance status |
0-1 |
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Dose and timing |
25Gy/10/2w for limited disease patients given after completion of concurrent chemoRT to chest if limited disease treated sequentially can give thoracic consolidation radiotherapy concurrent with PCI or give PCI after thoracic radiotherapy 20Gy/5/1w for extensive stage following response to SACT |