“Should I have radiation now?”
I have limited stage SCLC, they want to give me radiation therapy in addition to chemo to try and fix the tumor. Do I have any other options? Could I benefit at all from not doing this combination?
15 Answers
As a radiation oncologist, my bias and with compelling evidence depending on the clinical picture radiation and chemotherapy improve outcomes. The NCCN guidelines do include surgery for very early SCLC (1-2 A).
Chemotherapy and radiation given together is the standard treatment for your cancer. You don't have other options. You should have this treatment.
Survival is improved with the addition of radiation during the first or second cycle of chemotherapy (randomized studies have proven this with high certainty). You should get radiation.
Radiation and chemotherapy are the standard of care for this condition. The combination is superior to chemotherapy alone.
Yes. It is better to have consolidation radiation therapy after chemotherapy for minimal disease than treat after recurrence. Tumor recurs after chemotherapy is more resistant and more aggressive and spreads fast.
Concurrent chemotherapy and radiation is the Standard of Care in limited stage SCLC and proven to give high probability of local tumor control.
The standard of care for limited stage SCLC is chemotherapy followed by radiation therapy. Chemotherapy alone will not control the tumor in the lungs. It has to be followed by Radiation Therapy. There are really no alternatives to this recommended treatment. If you have a complete response , meaning the tumor has completed disappeared then consideration should be given for "prophylactic" radiation therapy to the brain. Please discuss this with you oncologist before you embark on any treatment
The standard and preferred option is to do them both as was recommended to you. It provides a higher chance of control. Doing them separately is just not as good.
You need @ least 2 or 3 courses of
You need 2 or 3 courses of Chemo. Rx to shrink the tumor as much as possible. You then need consolidation Radiation Rx. to the residual tumor, since it is very hard to get tumoricidal doses of Chemo. Rx. into the middle of a large mass, because the circulation into the middle of the mass is so poor.
Radiation goes right thru everything to kill the tumor cells.
You need 2 or 3 courses of Chemo. Rx to shrink the tumor as much as possible. You then need consolidation Radiation Rx. to the residual tumor, since it is very hard to get tumoricidal doses of Chemo. Rx. into the middle of a large mass, because the circulation into the middle of the mass is so poor.
Radiation goes right thru everything to kill the tumor cells.
Yes. SCLC is very sensitive to radiation. It is useful at the primary tumor site and to prevent brain metastases (prophylactic cranial irradiation=PCI)
Combining chemo with radiation provides a higher chance of control for limited stage SCLC. For extensive stage, chemo is the primary treatment modality with radiation used only to relieve symptoms if no response to chemo.
Thank you for your questions. Well designed studies have shown that concurrent chemotherapy and radiation therapy will improve not only local control but also survivals in patients with limited stage small cell lung cancer. If you have a good response to chemoradiation, you will also benefit from a course of prophylactic whole brain radiation therapy.
Unfortunately, SCLC is an extremely aggressive disease. Your doctors have proposed to you what would be considered the "standard of care", and represents what newer treatments are compared against. Without any treatment the average survival is about 2-4 months; but with combined chemotherapy and radiation, this improves to 18-24 months. Your doctors are also likely to propose "prophylactic cranial irradiation" or PCI. This is treating your brain with radiation, even though you don't have any cancer there, after all the other chemotherapy treatments are completed. It may sound ridiculous, but this has been shown to improve the number of patients surviving at 3 years from 15% to 20%. Thought of another way, PCI will help 1 out of every 4 patients make it to 3 years.
While every patient is unique and there exceptions to every rule, not doing combined chemotherapy and radiation for your SCLC is likely to result in a greatly shortened life.
While every patient is unique and there exceptions to every rule, not doing combined chemotherapy and radiation for your SCLC is likely to result in a greatly shortened life.
The answer is yes. The earlier you start
the radiotherapy in combination with the
chemotherapy, the better is the result.
the radiotherapy in combination with the
chemotherapy, the better is the result.
Limited stage small cell lung cancer responds to combination therapy with radiation and chemotherapy for long-term survival. Surgery may not be necessary. No treatment is another option which is fraught with lower survival due to rapid spread of cancer.
