Main Session
Sep 29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care

3597 - International Practice Patterns in the Management of Limited Stage Small Cell Lung Cancer

03:45pm - 05:00pm ET
Poster Hall - Exhibit Hall A
Screen: 33
POSTER

Presenter(s)

Neelabh Rastogi, MD - University of Toronto, Toronto, ON

N. K. Rastogi1, G. J. Li1, M. X. Qu2,3, S. Senan4, D. A. Palma2,3, S. Alfaifi5, A. H. Safavi6, M. Tjong6, and A. V. Louie6; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Division of Radiation Oncology, Western University, London, ON, Canada, 3Verspeeten Family Cancer Centre, London, ON, Canada, 4Department of Radiation Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands, 5Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, 6Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Purpose/Objective(s):

The management of limited stage small cell lung cancer (LS-SCLC) is evolving, with new data in primary dose fractionation, adjuvant immunotherapy (IO) and the utility of prophylactic cranial irradiation (PCI). Given these and other developments, the aim of this study was to characterize contemporary global LS-SCLC practice patterns.

Materials/Methods:

A 45-question online survey was developed to elicit lung radiation oncologist (LRO) demographics and their management of LS-SCLC. LROs within our institutions piloted the survey to optimize content validity and usability. The survey was then distributed through email and on social media to LROs worldwide. Data was collected anonymously and descriptive statistics were performed to analyze responses.

Results:

Eighty-five LROs responded with the following characteristics: 36% aged 40-49 years (n=31), 35% aged 25-39 years (n=30), 28% (n=24) in practice for 5-10 years, and 27% (n=23) in practice for 10-15 years. There was global representation from North America (40%, n=34), Europe (27%, n=23), Asia (21%, n=18), Australasia (6%, n=5), South America (5%, n=4), and Africa (1%, n=1).

Fifty-nine percent (n=50) of LROs preferred BID fractionation, with 78% (n=39) preferring standard dosing of 45Gy/30, 12% (n=6) incorporating a simultaneous integrated boost of 54Gy/30 to the gross tumor volume and 10% (n=5) reporting BID dose escalation to 60Gy/40. Of those preferring once daily dosing, 60% (n=21) preferred conventional 60-66Gy/30-33 and 34% (n=12) hypofractionated 40-45Gy/15. Seventy-nine percent of LROs (n=67) reported routine use of adjuvant durvalumab for 24 months post concurrent chemoradiation. Five percent (n=4) of LROs follow more stringent institutionalized dosimetric constraints when adjuvant IO is planned, while 31% (n=26) of LROs would be more cautious than their institution’s standard dosimetric constraints. Almost all LROs (95%, n=19) in centers where IO and dose escalation are routinely utilized would continue to dose escalate even with adjuvant IO planned. Prior to the implementation of adjuvant IO, nearly 3/4 of LROs (68%, n=58) would offer PCI, however of these, nearly half (43%, n=25) would now favor MRI brain surveillance.

Conclusion:

The results of this survey suggest considerable global differences in LS-SCLC management. Updated international guidelines and novel clinical trials may be beneficial to standardize practice.