Management of Small-Cell Lung Cancer with Radiotherapy—A Pan-Canadian Survey of Radiation Oncologists

Abstract

Background: The management of small-cell lung cancer (SCLC) with radiotherapy (RT) varies, with many treatment regimens having been described in the literature. We created a survey to assess patterns of practice and clinical decision-making in the management of SCLC by Canadian radiation oncologists (ROS). Methods: A 35-item survey was sent by e-mail to Canadian ROS. The questions investigated the role of RT, the dose and timing of RT, target delineation, and use of prophylactic cranial irradiation (PCI) in limited-stage (LS) and extensive-stage (ES) SCLC. Results: Responses were received from 52 eligible ROS. For LS-SCLC, staging (98%) and simulation or dosimetric (96%) computed tomography imaging were key determinants of RT suitability. The most common dose and fractionation schedule was 40–45 Gy in 15 once-daily fractions (40%), with elective nodal irradiation performed by 31% of ROS. Preferred management of clinical T1/2aN0 SCLC favoured primary chemoradiotherapy (64%). For ES-SCLC, consolidative thoracic RT was frequently offered (88%), with a preferred dose and fractionation schedule of 30 Gy in 10 once-daily fractions (70%). Extrathoracic consolidative RT would not be offered by 23 ROS (44%). Prophylactic cranial irradiation was generally offered in LS-SCLC (100%) and ES-SCLC (98%) after response to initial treatment. Performance status, baseline cognition, and pre-PCI brain imaging were important patient factors assessed before an offer of PCI. Conclusions: Canadian ROS show practice variation in SCLC management. Future clinical trials and national treatment guidelines might reduce variability in the treatment of early-stage disease, optimization of dose and targeting in LS-SCLC, and definition of suitability for PCI or consolidative RT.