Table 2.
KQs in Population, Intervention, Comparator, Outcome (PICO) format
| KQ | Population | Intervention | Comparator | Outcomes | |||
|---|---|---|---|---|---|---|---|
| 1 | What are the indications, appropriate dose-fractionation schedules, techniques, and timing of thoracic RT for LS-SCLC? | ||||||
| Patients with pathologically confirmed LS-SCLC with no evidence of M1 disease | • | • Twice daily RT |
• | • Once daily RT to moderate dose (≤5000 cGy) |
• | • OS |
|
| • | • Once daily RT to higher dose (>5000 cGy) |
• | • Starting thoracic RT at beginning of cycle 1 or cycle 2 of chemo |
• | • Progression-free survival |
||
| • | • Starting thoracic RT after cycle 2 of chemo or in between chemo cycles |
• | • Elective nodal irradiation |
• | • Local control |
||
| • | • Involved field RT |
• | • 3-D CRT |
• | • Grade ≥3 esophagitis |
||
| • | • Adjuvant RT |
• | • Grade ≥3 pneumonitis |
||||
| • | • IMRT |
• | • Major cardiac events |
||||
| • | • Proton therapy |
• | • Hematologic toxicity |
||||
| • | • Hypofractionated RT |
• | • Quality of life |
||||
| 2 | What is the role of SBRT compared with conventional RT in stage I or II node negative SCLC? | ||||||
| Patients with pathologically confirmed AJCC stage IA, IB, or IIA LS-SCLC | • | • SBR |
• | • Conventionally fractionated RT |
• | • OS |
|
| • | • Use of chemo before or after SBRT |
• | • SBRT alone without chemo |
• | • Progression-free survival |
||
| • | • Local control |
||||||
| • | • Nodal control |
||||||
| • | • Distant metastasis-free survival |
||||||
| • | • Grade ≥2 toxicities to the lungs, mediastinal structures, chest wall/ribs, brachial plexus |
||||||
| 3 | What are the indications, appropriate dose-fractionation schedules, and timing of prophylactic cranial RT for LS- and ES-SCLC? | ||||||
| Patients with pathologically confirmed SCLC with no known brain metastases | • | • PCI |
• | • MRI brain surveillance/clinical observation followed by salvage whole brain RT |
• | • Brain metastasis-free survival |
|
| • | • Dose-fractionation schedules for PCI other than 2500 cGy in 10 fx |
• | • PCI in 2500 cGy in 10 fx |
• | • Time to development of brain metastasis |
||
| • | • Different timing of PCI and chemo |
• | • Progression-free survival |
||||
| • | • Different timing of thoracic RT and PCI |
• | • Quality of life |
||||
| • | • Neurocognitive function |
||||||
| • | • Neurotoxicities |
||||||
| 4 | What are the indications, appropriate dose-fractionation schedules, and timing of thoracic consolidation in patients with ES-SCLC? | ||||||
| Patients with pathologically confirmed ES-SCLC | • | • Thoracic RT consolidation |
• | • Chemo alone without thoracic RT consolidation |
• | • OS |
|
| • | • Different dose-fractionation schedules for consolidation |
• | • Elective (not palliative) treatment of distant metastatic disease |
• | • Local control |
||
| • | • Different timing of RT and chemo |
• | • Grade ≥3 acute and late toxicities |
||||
Abbreviations: 3-D CRT = 3-dimensional conformal radiation therapy; AJCC = American Joint Committee on Cancer; chemo = chemotherapy; ES = extensive-stage; fx = fractions; IMRT = intensity modulated radiation therapy; KQs = key questions; LS = limited-stage; MRI = magnetic resonance imaging; OS = overall survival; PCI = prophylactic cranial irradiation; RT = radiation therapy; SBRT = stereotactic body radiation therapy; SCLC = small cell lung cancer.