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20 Cards in this Set

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SCLC - early vs late RT

Two meta analyses - RT before cycle 3 improves 2 and 5yOS

SCLC - paraneoplastic syndromes?


how to treat neurologic paraneoplasitc syndromes?

SIADH, cushing, neurological(subacute peripheral sensory neuropathy & L-E). Treat neurologic with IVIG and plasmapheresis, does not respond to chemotherapy

SCLC - prognostic factors

PS most important, female gender(beter), cushing syndrome, continued smoking, LDH, CEA

SCLC - staging for all patients

high res chest CT, PET-CT, brain MRI

SCLC - differnce between carbo and cis

Non, carbo less toxic.

SCLC - irino studies

Cis-irino vs cis-VP. significant survival benefit for irino with mOS 9--12 and 2yOS 5%-->19%.


American studies showed no difference in response, TTP or survival

SCLC - definitions of platinum sensitive or refractory and chance for response

sensitive - relapse >3m, refractory <3m.

Sensitive RR 50% of first line, mOS from 2nd line 6m. refractory <10%, mOS 4m


SCLC - 2nd line regimens - topotecan IV, oral

Topotecan IV - 38% RR in sensitive, 6% in refractory. Oral topotecan vs IV - RR ~15-20%, mOS 25-30weeks. Oral topotecan vs BSC mOS 14-->26w

SCLC - 2nd line recommendations

platinum sensitive - topotecan or CAV. for patients with response >6m for 1st line cis-VP consider rechallenege with cis-VP.

SCLC - concomitant CRT benefit

5.5% in 3yOS (with old AC based chemo)

SCLC - PCI benefit in terms of reduction of brain mets and OS

Reduction in brain mets from 24 to 6%, 1y freedom from symptomatic brain mets 14--40%, 1yOS benefit 13-->27% (EORTC), 3y 15-21% in different study

Lung carcinoid - fraction from carcinoids in total, types, criteria to distinguish

25% of all carcinoids. Typical are low grade with 2-10 mitoses per mm2, atypical are intermediate grade >=11 mitoses.


KI67 = typical 5%, atypical 10-30%




note SCLC 70-80 mitoses, KI 80-100%

Lung carcinoid - presentation, diagnosis

IUsually major bronchi, carcinoid syndrome rare. octreotide scan highly sensitive and specific, PET not so much. Urine 5-HIAA.

Lung carcinoid - staging

same as NSCLC!!! 90% stage 1!

Lung carcinoid - treatment for stages I-III, who gets adjuvant chemo, who gets adjuvant RT

resection as for NSCLC, NO ROLE FOR ADJUVANT chemo, adjuvant Rt for R1 and N2

Lung carcinoid - stage IV treatment

generally SCLC regimens with less sensitivity, may try octreotide

Large cell lung - presentation, behavior, paraneoplastic

Usually peripheral tumors, behave like SCLC. Paraneoplastic rare.

Large cell lung - staging, prognostic factors

staging like NSCLC! (also uptake PET!), prognostic factors are stage and size <>3cm

Large cell lung - adjuvant chemo

conflicting data - Cis/carbo VP as adjuvant probably improves survival for completely resected tumors, esp stage I.

Large cell lung - treatment for patients unable to undergo surgery. treatment for stage IV

Those unable to undergo surgery -definitive RT.


stage IV -s use protocols for SCLC.