Performance status (PS) and the physiologic status of the patient should guide treatment decision rather than the patient’s chronologic age. It is clear that elderly patients with good PS (ECOG 0 or 1) and normal organ function should be treated with optimal chemotherapy (and radiotherapy if indicated) as in their younger counterparts. Similar outcomes for elderly patients (in comparison to their younger counterparts) with limited-stage SCLC have been shown in the Intergroup trial 0096 in which cisplatin, etoposide, and thoracic radiotherapy was administered once per day or twice daily. The National Cancer Institute of Canada performed a retrospective review of their BR3 and BR6 trials and also concluded that age did not appear to impact the delivery, tolerance, or efficacy of thoracic irradiation in the combined modality management of limited-stage SCLC. Greater myelosuppression is to be expected because equivalent exposure to drug will lead to more myelosuppression in the elderly. This has been shown to be the case with etoposide. Greater ancillary support therefore will be required in the elderly. However, despite treatment delays, elderly patients with good PS derive the same level of benefit relative to younger patients.
We organized a systematic review of the published SCLC Literature to update the previous American College of Chest Physicians guideline. Supplemental material appropriate to this topic was obtained by literature search of a computerized database (MEDLINE) and review of the Thoracic Oncology NetWork reference lists of relevant articles. Recommendations were developed by the writing committee, graded by a standardized method (see “Lung Cancer” chapter) and reviewed by all members of the lung cancer panel before approval by the Thoracic Oncology Network, Health and Science Policy Committee, and the Board of Regents of the American College of Chest Physicians.
Accompanying this guideline is an “Evidence for Management of SCLC’ chapter, comprehensive research of some of the most controversial but not infrequently encountered questions in SCLC. In relevant sections of this guideline, the reader will be referred to this evidence report (see “SCLC Evidence” chapter).
This document presents an evidence-based guideline based on the current literature on the staging and optimal treatment of patients with small cell lung cancer (SCLC). The quality of the recommendation and the evidence on which it is based is graded as outlined by the American College of Chest Physicians grading system task force. Accompanying this guideline is an evidence report titled “Evidence for Management of SCLC.” Nine key questions were addressed by the technical report and are the following (see chapter “SCLC Evidence”).
1. What are the relative benefits or harms of combining thoracic radiotherapy (TRTx) with chemotherapy in alternating, concurrent, or sequential fashion?
2. Does early vs late administration of TRTx influence outcome?
3. Does the duration of administration of TRTx affect survival or toxicity?