Treatment Of Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Publication Date: November 1, 2013
Last Updated: March 14, 2022
Recommendations
Staging of SCLC
In patients with SCLC (proven or suspected), a staging evaluation is recommended consisting of a medical history and physical examination, CBC and comprehensive chemistry panel with renal and hepatic function tests, CT of the chest and abdomen with intravenous contrast or CT scan of the chest extending through the liver and adrenal glands, MRI or CT of the brain, and bone scan. (1, B)
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In patients with clinically limited-stage (LS)-SCLC, PET imaging is suggested. (2, C)
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In patients with SCLC, it is recommended that both the Veterans Administration system (LS vs extensive stage [ES]) and the American Joint Committee on Cancer/International Union Against Cancer seventh edition system (TNM) should be used to classify the tumor stage. (1, B)
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Role of Surgery
In patients with clinical stage I SCLC, who are being considered for curative intent surgical resection, invasive mediastinal staging and extrathoracic imaging (head MRI/CT and PET or abdominal CT plus bone scan) is recommended. (1, B)
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In patients with clinical stage I SCLC after a thorough distant and invasive mediastinal stage evaluation, surgical resection is suggested over non-surgical treatment. (2, C)
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In patients with stage I SCLC who have undergone curative-intent surgical resection, platinum-based adjuvant chemotherapy is recommended. (2, C)
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Use of RT for SCLC
In patients with LS-SCLC, early chemoradiotherapy, with accelerated hyper-fractionated radiation therapy (twice-daily treatment) concurrently with platinum-based chemotherapy, is recommended. (1, B)
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In patients with LS- or ES-SCLC who achieve a complete or partial response to initial therapy, PCI is recommended. (1, B)
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In patients with ES-SCLC who have completed chemotherapy and achieved a CR outside the chest and complete or partial response in the chest, a course of consolidative TRT is suggested. (2, C)
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Novel Therapies
In patients with either LS or ES-SCLC, four to six cycles of platinum-based chemotherapy with either cisplatin or carboplatin plus either etoposide or irinotecan is recommended over other chemotherapy regimens. (1, A)
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Second-line Treatment of SCLC
In patients with relapsed or refractory SCLC, the administration of second-line, single-agent chemotherapy is recommended. (1, B)
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Treatment of SCLC in the Elderly
In elderly patients with LS-SCLC and good PS (ECOG 0-2), treatment with platinum- based chemotherapy plus TRT is suggested, with close attention to management of treatmentrelated toxicity. (2, B)
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In elderly patients with ES-SCLC and good PS (ECOG 0-2), treatment with carboplatin-based chemotherapy is suggested. (2, A)
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In elderly patients with SCLC and poor PS, treatment with chemotherapy is suggested if the poor PS is due to SCLC. (2, C)
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Title
Treatment Of Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Authoring Organization
American College of Chest Physicians
Publication Month/Year
November 1, 2013
Last Updated Month/Year
August 24, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
Small cell lung cancer (SCLC) is a lethal disease for which there have been only small advances in diagnosis and treatment in the past decade. Our goal was to revise the evidence-based guidelines on staging and best available treatment options.
Target Patient Population
Patients with small cell lung cancer
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Home health, Hospice, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D013903 - Thoracic Surgery, D055752 - Small Cell Lung Carcinoma, D018288 - Carcinoma, Small Cell, D016371 - Cranial Irradiation, D060830 - Consolidation Chemotherapy
Keywords
lung cancer, management, small cell lung cancer