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Radiotherapie voor het SCLC

Small cell lung cancer. 20% van longkankers1/3 is limited" diseaseMedian survival 2- 4 mnd.Chemo Rx hogere mediane survival doch slechts weinig lange termijn overleving.Radiotherapie ?Meta-analyse. Radiotherapie meta-analyses. Pignon et al. NEJM '92Warde et al. JCO '92Local failure rate ?50%

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Radiotherapie voor het SCLC

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    1. Radiotherapie voor het SCLC

    2. Small cell lung cancer 20% van longkankers 1/3 is “limited” disease Median survival 2- 4 mnd. Chemo Rx hogere mediane survival doch slechts weinig lange termijn overleving. Radiotherapie ? Meta-analyse

    3. Radiotherapie meta-analyses Pignon et al. NEJM ’92 Warde et al. JCO ’92 Local failure rate ?50% Absolute winst na 2 jr : 5,4 % Totale 5 jrs survival blijft 10-15 % Chemo-radiatie is eerste keus behandeling ! Mediane survival 16- 24 mnd Sequentie? Concurrent vs. sequentieel Timing ? Early vs. late Optimal total treatment time ? Dosis en fractionering ?

    4. Timing : early vs. late 30 dagen Geen verschil in 2jrs of 5 jrs survival Wel 5 jrs survival als platinum bevattende chemo of total treatment time < 30 dgn Local control geen significant verschil Ook niet voor platinum

    5. Toxiciteit hoger : oesophagitis ; haematologisch Zelde voor platinum of < 30 dagen OTT 5 jrs survival 20,2 mnd early vs. 13,8 mndn late Goede PS, goed gestageerd, goede therapie compliance

    6. Sequencing Concurrent voorkeur Early beter dan late 1 gerandomiseerde studie :Takada et al. JCO 2002 chemo Rx : 4x C-E / 3 wks (seq.) resp. 4 wks (conc.) Rath. : 45 Gy / 30 F/ 3 wks dag 2 vs. na 4e kuur 5 jrs surv. 23,7% (conc) vs. 18,3 % (seq) niet sign., wel trend, kleine sample size Geen studies over electieve lnn. bestraling Dosis : zo hoog als bij NSCLC ?

    7. Profylactische hersen bestraling

    8. Profylaxe

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