Staging for Limited Disease SCLC and impact of PET/CT

To assess if all patients with limited disease small cell lung cancer were staged with brain imaging.

Small cell lung cancer is an aggressive malignancy but if treated with chemotherapy and radiotherapy at the limited disease (LD) stage can be cured (1). NICE advocates staging with brain imaging, and alludes to a PET/CT scan for radical lung therapy (2). In contrast to NSCLC (3 ) the impact of PET/CT staging has not been clearly defined ( 4). We have local guidelines that recommend brain imaging and PET/CT for LD SCLC.

The standard: 

All patients with LD SCLC should be appropriately staged with brain imaging.

Target: 

Brain staging for those given radical lung radiotherapy 100%. PET /CT staging considered in 100%

Indicators: 

Brain staging for those given radical lung radiotherapy 100%. PET /CT staging 100%

Data items to be collected: 

Search local database of all patients treated within radical lung radiotherapy during a certain time frame to determine the number of LD SCLC patients staged with a PET/CT scan and their outcomes.

Additional data was should be acquired on whether a patient needed to be treated with urgent / emergency chemotherapy (for conditions such as SVCO) which may have prevented them accessing a PET/CT scan.

Suggested number: 

50 patients

Feed back to MDMs and clinicians about staging guidelines for brain imaging. In an era of constraints on PET/CT imaging PET/CT scanning should not be viewed as compulsory.

1. Curran W et al “ Sequential vs Concurrent Chemoradiation for Stage III Non–Small Cell Lung Cancer: Randomized Phase III Trial RTOG 9410” JNCI 2011; 103 (19) : 1452 – 1460

2. NICE guidance CG 121 Lung cancer: diagnosis and management; https://www.nice.org.uk/guidance/cg121?unlid=6344740562016101116919

3. Kalff V et al “Clinical Impact of 18F Fluorodeoxyglucose Positron Emission Tomography in Patients With Non–Small-Cell Lung Cancer: A Prospective Study” JCO 2001; 19(1) 111-118

4. Van loon J et al “ Selective nodal irradiation on basis of 18FDG PET scans in limited disease small cell lung cancer: a propsective study” IJRBOP 2010 77(2): 329-336

Ryan Wilson

Co-authors

Jonathan McAleese

Thomas Lynch

Gerard G. Hanna