• Lung Cancer Diseases Site Group. The role of thoracic radiotherapy as an adjunct to standard chemotherapy in limited-stage small cell lung cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Jan [online update]. 20 p. (Practice guideline; no. 7-13-3). [30 references]

• In patients with limited-stage small cell lung cancer, the addition of thoracic radiotherapy to standard combination chemotherapy improves both local control and overall survival and should be incorporated into a comprehensive treatment plan of combined modality therapy for limited-stage small cell lung cancer.
• The data from randomized trials suggest that higher doses of thoracic radiotherapy produce better local control and progression-free survival. Although the optimal dose has not yet been established, those trials that demonstrate a superior survival outcome from radiotherapy and chemotherapy over chemotherapy alone have generally used a total dose of at least 40 Gy in 15 fractions over three weeks (or a biologically equivalent dose). The radiation oncologist must assess the appropriateness and safety of this recommendation for individual patients, taking into consideration tumour field size and location, pulmonary function tests and other clinical factors. These factors are important as the improvement in overall survival occurs with an increased risk of death due to the toxicity of combined modality therapy.
• There is conflicting evidence as to the optimal timing of thoracic radiotherapy in relation to the course of chemotherapy (early or late administration of thoracic radiotherapy). The evidence is also conflicting regarding the issue of concurrent versus sequential administration of chemotherapy with radiotherapy.
• Based on currently available data, hyperfractionated thoracic radiotherapy is NOT recommended for limited-stage small cell lung cancer outside of a clinical trial.

None provided

1999 Guideline

Two published meta-analyses comparing chemotherapy plus thoracic radiotherapy (TRT) with chemotherapy alone were eligible for review. The first meta-analysis analyzed published results from 11 trials and the second examined individual patient data from 13 trials; there was substantial overlap between the trials analyzed in the two meta-analyses. Nine randomized controlled trials were also eligible for review (six were fully published). Six of the nine randomized controlled trials investigated the timing of TRT delivery. The Cancer Care Ontario Practice Guidelines Initiative's (CCOPGI's) Resource Group pooled published data from four randomized controlled trials examining early versus late TRT delivery. One of the nine randomized controlled trials analyzed optimal dosage of TRT delivered in conjunction with chemotherapy, while two randomized controlled trials examined single- versus twice-daily TRT treatment in conjunction with chemotherapy.

2003 Update

Seven papers identified by a literature search from October 2000 to December 2002 were eligible for inclusion in the systematic review of the evidence. Two of these papers led the Lung Cancer Disease Site Group to modify its recommendations in October 2000. One paper reported a trial that compared chemotherapy combined with either concurrent or alternating radiotherapy. The other paper was the full report of a trial previously published in abstract form that compared chemotherapy plus daily radiotherapy versus chemotherapy plus twice-daily radiotherapy. Five additional reports of randomized trials were found, one of which included updated results for a trial included in the original guideline report.

• Lung Cancer Diseases Site Group. The role of thoracic radiotherapy as an adjunct to standard chemotherapy in limited-stage small cell lung cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Jan [online update]. 20 p. (Practice guideline; no. 7-13-3). [30 references]

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

1999 Oct 8 (updated online 2003 Jan)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario, Ontario Ministry and Health Long-Term Care

Lung Cancer Disease Site Group

Members of the Lung Cancer Disease Site Group disclosed potential conflict of interest information.

None available

This summary was completed by ECRI on June 5, 2002. The information was verified by the guideline developer as of July 8, 2002. This summary was updated on August 6, 2003. The updated information was verified by the guideline developer on September 2, 2003.