A national open meeting is limited-disease sclc. is the main consultative phase of Scottish limited-disease sclc Intercollegiate Guidelines Network (SIGN) guideline development, at which the guideline development group presents its draft recommendations for the first time. The national open meeting for this guideline was held in February 2004 and was attended by all of the key specialties relevant to the guideline. The draft guideline was also available on the SIGN website for one month to allow those unable to attend the meeting to contribute to the development of the guideline.
The guideline was also reviewed in draft form by a panel of independent expert referees, who were asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence base supporting the recommendations in the guideline.
As a final quality control check, the guideline is reviewed by an Editorial Group comprising the relevant specialty representatives on SIGN Council to ensure that the peer reviewers' comments have been addressed adequately and that any risk of bias in the guideline development process as a whole has been minimised.
A meta-analysis evaluating the benefit of chemotherapy in patients with non-small cell lung cancer (NSCLC) concluded that there is a median survival improvement of around six weeks and a 10% increase in one year survival with cisplatin-based regimens.
Photodynamic therapy (PDT), brachytherapy, electrocautery, cryotherapy, stents and Nd-YAG laser therapy are therapeutic options available for the management of endobronchial malignancies. They may be used in the curative treatment of early stage lung cancers or, more commonly, in the palliative management of tumours causing airway obstruction.
If bolus etoposide-cisplatin is selected as the treatment of choice, there is evidence from one randomized trial that the optimal sequence of administration of the components of the regimen is cisplatin followed by etoposide. The total dose of etoposide per cycle of chemotherapy should be administered in divided doses given daily over three to five days.
The optimal duration of chemotherapy treatment is uncertain. There is insufficient evidence to recommend a specific number of treatment cycles. There is no evidence that maintenance chemotherapy (i.e., chemotherapy beyond six cycles provided to patients who have shown a response to the original chemotherapeutic regimen) prolongs survival, and, therefore, a maximum of six cycles is recommended.
Although carboplatin is commonly substituted for cisplatin in the etoposide-cisplatin combination, there are insufficient data from clinical trials to support this substitution in patients with limited small-cell lung cancer being treated with curative intent.
Only 10 trials of the 50 trials reviewed in this guideline focused exclusively on limited-stage disease, and, in the remaining trials, the number of patients with limited-stage disease was generally small. The evidence for an optimal chemotherapy regimen for this patient population must be interpreted in light of these limitations.
Care has been taken in the preparation of the information contained in this document. Nonetheless, any person seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances or seek out the supervision of a qualified clinician. Cancer Care Ontario makes no representation or warranties of any kind whatsoever regarding their content or use or application and disclaims any responsibility for their application or use in any way.
Tags:
