Sclc

Front 1

SCLC - early vs late RT

Back 1

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

Front 2

SCLC - paraneoplastic syndromes?

how to treat neurologic paraneoplasitc syndromes?

Back 2

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

Front 3

SCLC - prognostic factors

Back 3

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

Front 4

SCLC - staging for all patients

Back 4

high res chest CT, PET-CT, brain MRI

Front 5

SCLC - differnce between carbo and cis

Back 5

Non, carbo less toxic.

Front 6

SCLC - irino studies

Back 6

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

Front 7

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

Back 7

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

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

Front 8

SCLC - 2nd line regimens - topotecan IV, oral

Back 8

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

Front 9

SCLC - 2nd line recommendations

Back 9

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

Front 10

SCLC - concomitant CRT benefit

Back 10

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

Front 11

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

Back 11

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

Front 12

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

Back 12

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%

Front 13

Lung carcinoid - presentation, diagnosis

Back 13

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

Front 14

Lung carcinoid - staging

Back 14

same as NSCLC!!! 90% stage 1!

Front 15

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

Back 15

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

Front 16

Lung carcinoid - stage IV treatment

Back 16

generally SCLC regimens with less sensitivity, may try octreotide

Front 17

Large cell lung - presentation, behavior, paraneoplastic

Back 17

Usually peripheral tumors, behave like SCLC. Paraneoplastic rare.

Front 18

Large cell lung - staging, prognostic factors

Back 18

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

Front 19

Large cell lung - adjuvant chemo

Back 19

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

Front 20

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

Back 20

Those unable to undergo surgery -definitive RT.

stage IV -s use protocols for SCLC.