From the Guidelines
Small Cell Lung Cancer (SCLC) chemoradiation therapy is typically administered concurrently, combining chemotherapy and radiation therapy for optimal outcomes, with the standard chemotherapy regimen consisting of platinum-based agents (cisplatin or carboplatin) combined with etoposide, as recommended by the most recent guidelines 1. The chemotherapy regimen is administered every 3-4 weeks for 4-6 cycles, with cisplatin usually given at 60-80 mg/m² on day 1, and etoposide administered at 80-120 mg/m² on days 1-3 of each cycle. Some key points to consider in the administration of SCLC chemoradiation therapy include:
- Radiation therapy is delivered simultaneously with chemotherapy, typically at doses of 45-70 Gy over 5-7 weeks (1.8-2 Gy per fraction daily) 1.
- For limited-stage SCLC, early concurrent CRT is preferred, ideally starting with the first or second cycle of chemotherapy, as this approach has demonstrated superior survival outcomes compared to sequential therapy 1.
- Twice-daily radiation (hyperfractionation) at 1.5 Gy per fraction may be considered for fit patients, as it has been shown to improve survival outcomes in some studies 1.
- Patients require close monitoring for side effects including myelosuppression, esophagitis, pneumonitis, and nausea, and prophylactic cranial irradiation (PCI) at 25 Gy in 10 fractions is often recommended after CRT completion for patients with good response to reduce the risk of brain metastases 1. The most recent and highest quality study 1 provides the strongest evidence for the administration of SCLC chemoradiation therapy, and its recommendations should be followed in clinical practice.
From the FDA Drug Label
The recommended dose of topotecan is 1.5 mg/m2 by intravenous infusion over 30 minutes daily for 5 consecutive days, starting on day 1 of a 21-day course. The administration of Small Cell Lung Cancer (SCLC) chemoradiation therapy (CRT) involving topotecan is by intravenous infusion.
- The dose is 1.5 mg/m2
- Administered over 30 minutes
- Given daily for 5 consecutive days
- Starting on day 1 of a 21-day course 2
From the Research
Administration of SCLC Chemoradiation Therapy (CRT)
The administration of Small Cell Lung Cancer (SCLC) chemoradiation therapy (CRT) involves a combination of chemotherapy and radiation therapy.
- The chemotherapy regimen typically consists of cisplatin and etoposide, given intravenously over several days, with cycles repeated every few weeks 3, 4.
- Radiation therapy is administered concurrently with chemotherapy, with a total dose of 40-50 Gy given in standard fractions over several weeks 3.
- The radiation therapy is typically given to the primary tumors at both the hili and the mediastinum, with prophylactic cranial irradiation performed in patients who achieve complete remission or good partial remission 3, 5.
- The treatment schedule and dosage may vary depending on the specific protocol and the patient's response to treatment 4.
Treatment Outcomes and Toxicity
The outcomes of SCLC CRT have been evaluated in several studies, with overall response rates ranging from 82% to 94.9% 3, 4.
- The median survival time for patients with limited-stage SCLC has been reported to be around 12-14 months, with 1-year survival rates ranging from 47% to 67% 3, 4.
- The treatment is associated with significant toxicity, including grade 3 and 4 neutropenia, esophagitis, and pneumonitis 3, 4, 6.
- Prophylactic cranial irradiation has been shown to reduce the development of brain metastases and improve survival in patients with both limited-stage and extensive-stage SCLC 5.
Role of Surgery in SCLC Treatment
Surgery may have a role in the treatment of SCLC in certain situations, such as in patients with clinical stage T1-2 N0 disease or those with a combined histology tumor 7.