title: Optimal Radiation Therapy for Small Cell Lung Cancer.
abstract: Radiation therapy plays an important role in the management of both limited stage and extensive stage small cell lung cancer. For limited stage disease, there has been a trend toward reduced size of thoracic radiation fields, which has the potential to reduce toxicity. FDG-PET staging helps make this possible by more accurately identifying areas of nodal and metastatic involvement. Trials have demonstrated similar outcomes using a range of radiation fractionation schedules, allowing flexibility in individualizing treatment. Using advanced radiation therapy techniques such as intensity-modulated radiation therapy, it may be possible to deliver fewer, higher dose fractions and achieve similar results to the hyperfractionated regimen. For extensive stage disease, consolidative thoracic radiation therapy after chemotherapy was recently shown to improve overall survival in certain patient subsets. Prophylactic cranial irradiation continues to play an important role in management of all stages of small cell lung cancer. Debate continues about the neurocognitive effects of this treatment, and whether MRI surveillance is an acceptable alternative. Strategies such as hippocampal avoidance may reduce the cognitive effects of prophylactic cranial irradiation in the future. Finally, in the last few years stereotactic ablative radiation therapy followed by chemotherapy has emerged as a promising treatment for stage I small cell lung cancer. This radiation treatment is usually given over 1-5 fractions and appears to provide a good rate of local control with a low rate of serious toxicity.
authors.affiliation: Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Dr., MC 5847, Stanford, CA, 94305, USA. mgens@stanford.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gensheimer
authors.affiliation: Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Dr., MC 5847, Stanford, CA, 94305, USA.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D019583:Dose Fractionation, Radiation; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000532:radiotherapy*
keywords: Intensity-modulated radiation therapy; Radiation therapy; Small cell lung cancer