Small cell lung CA

Small cell lung cancer
1. Staging/Inx
- CXR (optional)
- CT chest/liver/adrenal
- head MRI/CT
- bone scan vs PET scan
- LDH, Ca, LFT
a. Limited stage
- BMA
- thoracocentesis/thoracoscopy
- pulmonary function tests
- bone XR of areas showing abnormal uptake on bone/PET scan; if negative/inconclusive MRI bony lesions

2. Initial treatment
a. T1-2, mediastinal staging negative: lobectomy and mediastinal N0 chemotherapy, N+ concurrent chemoRT
b. concurrent chemoRT for PS 0-2, chemo+/-RT for poor PS due to SCLC
c. Extensive stage: not localised - combination chemotherapy, SVCO/lobar obs/bone mets/SC compression - chemo +/- RT to site, brain mets - WBRT

3. After initial treatment
- CR/PR/radiation scarring/less 10% mass: PCI
- follow-up 12-3mo during y1, every 3-4 mo dring y2-3, every 4-6mo during y4-5, then annually with bloods and chest imaging
- new pulm nodule after 2y - potential new primary

4. Chemotherapy as primary therapy
a. Limited stage
- cisplatin 60mg/m2 D1 and etoposide 120mg/m2 D1,2,3 x 4 cycles (recommended for chemoRT)
- carboplatin AUC 5-6 day 1 and etoposide 100mg/m2 days 1,2,3 x 4cycles

b. Extensive stage
- cisplatin 75mg/m2 D1 and etoposide 100mg/m2 D1,2,3 x 4-6 cycles
- cisplatin 80mg/m2 D1 and etoposide 100mg/m2 D1,2,3
- cisplatin 25mg/m2 D1,2,3 and etoposide 100mg/m2 days 1,2,3
- carboplatin AUC 5-6 D1, etoposide 100mg/m2 D1,2,3 x 4-6 cycles
- cisplatin 60mg/m2 on D14, irinotecan 60mg/m2 on D1/8/15
- carboplatin AUC 5 and irinotecan 50mg/m2 D1,8,15
- cyclophosphamide 1000mg/m2 D1 and doxorubicin 45mg/m2 D1 and vincristine 1.4mg/m2 D1

c. Subsequent chemotherapy
- clinical trial preferred
- relapse <2-3mo, PS 0-2: ifosfamide, paclitacel, docetaxel, gemcitabine, irinotecan, topotecan
- relapse >2-3mo up to 6mo: topotecan, irinotecan, cyclophosphamide/doxorubicin/vincristine (CAV), gemcitabine, paclitaxel, docetaxel, oral etoposide, vinorelbine
- relapse >6mo: original regimen