Treatment of Small‑Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians Guideline
For small‑cell lung cancer, concurrent chemoradiotherapy is recommended for limited‑stage disease; early thoracic radiotherapy, a platinum‑based chemotherapy regimen with etoposide, and prophylactic cranial irradiation improve survival, while extensive‑stage disease should receive a platinum agent plus etoposide or irinotecan.
PURPOSE: The American College of Chest Physicians (ACCP) produced an evidence‑based guideline on treatment of patients with small‑cell lung cancer (SCLC). Because of the relevance of this guideline to American Society of Clinical Oncology (ASCO) membership, ASCO reviewed the guideline, applying a set of procedures and policies used to critically examine guidelines developed by other organizations. METHODS: The ACCP guideline on the treatment of SCLC was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel updated the literature search, reviewed the content, and considered additional recommendations. RESULTS: The ASCO Endorsement Panel determined that the recommendations from the ACCP guideline, published in 2013, are clear, thorough, and based on current scientific evidence. ASCO endorses the ACCP guideline on the treatment of SCLC, with the addition of qualifying statements. RECOMMENDATIONS: Surgery is indicated for selected stage I SCLC. Limited‑stage disease should be treated with concurrent chemoradiotherapy in patients with good performance status. Thoracic radiotherapy should be administered early in the course of treatment, preferably beginning with cycle one or two of chemotherapy. Chemotherapy should consist of four cycles of a platinum agent and etoposide. Extensive‑stage disease should be treated primarily with chemotherapy consisting of a platinum agent plus etoposide or irinotecan. Prophylactic cranial irradiation prolongs survival in patients with limited‑stage disease who achieve a complete or partial response to initial therapy and may do so in similarly responding patients with extensive‑stage disease as well.
Clear, evidence‑based recommendations for the management of small‑cell lung cancer help clinicians choose optimal treatment strategies—chemoradiotherapy, early radiotherapy, platinum‑based chemotherapy, and prophylactic cranial irradiation—to improve patient outcomes and reduce morbidity.
Bizonyítékszint: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.
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