NCCN Insights focus on SCLC pathology, radiation therapy

  • Kalemkerian GP & al.
  • J Natl Compr Canc Netw
  • 01/10/2018

  • Oncology guidelines update
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Takeaway

  • The National Comprehensive Cancer Network (NCCN) has published NCCN Guidelines Insights on small-cell lung cancer (SCLC), including news sections on pathology and updated guidelines on radiation therapy (RT).

Why this matters

  • Results of several recent trials prompted an NCCN panel to update the SCLC guidelines.

Key highlights and recommendations

  • A new section on pathology, including signs and symptoms resulting from local primary tumor growth, primary tumor invasion, or regional lymphatic metastases, or from extrathoracic (hematogenous) metastases, as well as signs and symptoms of paraneoplastic syndromes.
  • A new section on principles of pathologic review, including pathologic evaluation and immunohistochemical staining.
  • Intensity-modulated radiation therapy is preferred over 3D conformal external-beam RT on the basis of reduced toxicity in the setting of concurrent chemotherapy/RT.
  • RT dose and schedule RT for limited-stage SCLC based on CONVERT trial results, between 45 Gy for twice-daily and 66 Gy for daily RT.
  • Adjuvant prophylactic cranial irradiation should be considered for patients with extensive-stage disease.

Limitations

  • Additional updates to the NCCN Guidelines for SCLC (version 1.2019) were made after this paper was approved, so clinicians should refer to the latest guidelines.