This is the current release of the guideline.

This guideline updates a previous version: Simon GR, Wagner H. Small cell lung cancer. Chest 2003 Jan;123(1 Suppl):259S-71S.

Definitions for the strength of evidence and recommendation grades (1A-2C) follow the recommendations.

1. Routine staging of small cell lung cancer (SCLC) includes history and physical examination, complete blood counts (CBCs) and comprehensive chemistry panel, computed tomography (CT) of the chest and abdomen or CT of the chest with cuts going through the entire liver and adrenal glands, CT or magnetic resonance imaging (MRI) of the brain, and bone scan. Grade of recommendation, 1B
2. Positron emission tomography (PET) is not recommended in the routine staging of SCLC. Grade of recommendation, 2B
3. Patients with extensive-stage disease should receive four to not more than six cycles of cisplatin or carboplatin-based combination chemotherapy. Cisplatin could be combined with either etoposide or camptothecin-11 (CPT-11). Grade of recommendation, 1B
4. After chemotherapy, patients achieving a complete response (CR) outside the chest and complete or partial response in the chest could be offered consolidative thoracic radiation therapy (TRTx) in the chest. Grade of recommendation, 2C
5. Outside of a clinical trial, maintenance treatment for patients with extensive-stage or limited-stage disease achieving a partial remission or CR is not recommended. Grade of recommendation, 1B
6. Patients with SCLC with relapsed or refractory disease should be offered further chemotherapy. Grade of recommendation, 1B
7. Elderly patients with good performance status (PS) (Eastern Cooperative Oncology Group [ECOG] PS 0 or 1) with intact organ function should be treated with platinum-based chemotherapy. Grade of recommendation, 1A
8. Elderly patients with poor prognostic factors such as poor PS or medically significant concomitant comorbid disease may still be considered for chemotherapy. Grade of recommendation, 2C
9. Outside of a clinical trial, there is no role of either dose dense/intense initial/induction or maintenance treatment for extensive-stage or limited-stage SCLC. Grade of recommendation, 1A
10. Patients with limited-stage SCLC should be treated with combined concurrent chemoradiotherapy. Patients require referral to a radiation oncologist and a medical oncologist for the consideration of combined modality treatment. Grade of recommendation, 1A
11. If the PS and comorbid illnesses allow, patients with limited-stage disease should be treated with chemotherapy and radiation therapy administered concurrently. Grade of recommendation, 1C
12. In patients eligible to receive early concurrent chemoradiotherapy, patients should be treated with accelerated hyperfractionated radiation therapy concurrently with platinum-based chemotherapy. Grade of recommendation, 1B
13. Patients with limited-stage SCLC achieving a complete remission or patients with stage I disease who have had resection should be offered prophylactic cranial irradiation (PCI). Grade of recommendation, 1B
14. Patients with extensive-stage SCLC achieving a complete remission should be offered PCI. Grade of recommendation, 1C
15. In patients with SCLC and stage I disease who are being considered for curative intent surgical resection, invasive mediastinal staging and extrathoracic imaging (head CT/MRI, abdominal CT plus bone scan) performed in all patients should be offered. Grade of recommendation, 1A
16. In patients with stage I SCLC who have undergone curative intent surgical resection, platinum-based adjuvant chemotherapy is recommended. Grade of recommendation, 2C
17. Patients with mixed SCLC/NSCLC histology should be treated like patients with SCLC. All the treatment recommendations made for SCLC should apply to this category of patients. Grade of recommendation, 2C

Definitions:

Quality of Evidence Scale

High - Randomized controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies*

Moderate - RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies*

Low or very low - Observational studies or case series

*Although the determination of magnitude of the effect based on observational studies is often a matter of judgment, the guideline developers offer the following suggested rule to assist this decision: a large effect would be a relative risk > 2 (risk ratio < 0.5) [which would justify moving from weak to moderate], and a very large effect is a relative risk > 5 (risk ratio < 0.2) [which would justify moving from weak to strong]. There is some theoretical justification in the statistical literature for these thresholds (the magnitude of effect that is unlikely or very unlikely to be due to residual confounding after adjusted analysis). However, once the decision is made, authors should be explicit in justifying their decisions.

Grade of Recommendations Scale

Relationship of Strength of the Supporting Evidence to the Balance of Benefits to Risks and Burdens

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 Jan (revised 2007 Sep)

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on Lung Cancer Guidelines

Primary Authors: George R. Simon, MD, FCCP; Andrew Turrisi, MD

American Association for Bronchology - Disease Specific Society
American Association for Thoracic Surgery - Medical Specialty Society
American College of Surgeons - Medical Specialty Society
American Society for Therapeutic Radiology and Oncology
Asian Pacific Society of Respirology - Disease Specific Society
Oncology Nursing Society - Professional Association
Society of Thoracic Surgeons - Medical Specialty Society
World Association of Bronchology - Disease Specific Society

This is the current release of the guideline.

This guideline updates a previous version: Simon GR, Wagner H. Small cell lung cancer. Chest 2003 Jan;123(1 Suppl):259S-71S.

This NGC summary was completed by ECRI on September 3, 2003. The information was verified by the guideline developer on October 1, 2003. This NGC summary was updated by ECRI Institute on November 28, 2007. The updated information was verified by the guideline developer on December 21, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.