Table 4.

Prioritizing Treatment Options for SCLC

Clinical Scenario	Treatment Recommendation	Initial Delay, wk	Workup	Comments
Limited Stage
Untreated	Concurrent chemotherapy and radiotherapy	<2	standard	if radiation therapy is not available start with chemotherapy and add XRT as early as possible
On treatment	Concurrent chemotherapy and radiotherapy followed by chemotherapy	<2	standard	continue with CCRT, keep cycles of chemotherapy to 4, use growth factors away from XRT
Completed treatment	PCI	2–8	standard
	Observation	>8	may delay imaging for a mo	Flow up by teleclinic
Extensive Stage
Untreated	Chemotherapy	<2	standard	should start on time. Consider growth factors or dose reduction, consider oral etoposide for d 2 and 3
	Chemotherapy and immunotherapy	<2	standard	Be selective
On treatment	chemotherapy	<2	may extend assessment for 3 cycles if stable
	Chemotherapy and immunotherapy	<2
Completed treatment	Observation	2–8	May extend up to 2 mo	if asymptomatic by teleclinic

CCRT, concurrent chemoradiation therapy; PCI, prophylactic cranial irradiation; XRT, radiation therapy.