Indications

‘Limited Stage’ = Any T, any N, M0 encompassable within radical volume

Performance status

0-1

Consider PS2 if expected to improve after first cycle chemo

Requires renal function sufficient for platinum (see SACT protocol)

Pulmonary function

‘Adequate’ function allowing for anticipated improvement after first cycle

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
(Acceptable to aim for cycle 2 day 1)

Chemotherapy

(see SACT pathway and local SACT protocols for administration and dosing details)

Cisplatin 80mg/m2+etoposide combination q3weeks 4 cycles total
Variety of etoposide dose regimens available
Can substitute carboplatin AUC5 for cisplatin if renal function poor

Limited SCLC SACT Pathways

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 
‘Adequate’ renal and pulmonary function for SACT

Performance status

0-2

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 

Limited SCLC SACT Pathways

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.

Treat higher dose for disease control following chemotherapy response OR
Treat lower dose for symptom control at presentation or progression
Life expectancy >4w

Performance status

0-3

Dose

30Gy/10/2w higher dose option/consolidation post chemo
20Gy/5/1w  lower dose option and for immediate symptom control
8-10Gy/1 symptom control

Extensive SCLC SACT Pathways

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
 Not to be given concurrent with SACT

Performance status

0-1

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