Drs. Leora Horn, Ben Solomon, & Jack West debate whether results from a European trial of chest radiation after chemotherapy for extensive stage small cell lung cancer should lead to a change in treatment for this setting.

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Dr. West:  Not a lot here on small cell lung cancer, but there are still a couple of pretty controversial questions, including what the role is for consolidation chest radiation in patients who have residual chest disease after a good, but incomplete, response to chemotherapy. What are you guys doing in that situation? Is this something that has become a standard, or something that you often recommend, or at least discuss with patients, or is it still not something that has penetrated into common practice; Ben?

Dr. Solomon:  Yeah, so I must admit, even prior to the results with the Slotman study, which was published in the New England Journal — or, no, it was presented at ASCO — about thoracic radiation after chemotherapy, I used to worry about patients who had residual disease in their chest, because you worry that that’s a site at which they’re going to progress, and we’ve had discussions with our radiation oncology colleagues about treating that, almost preemptively. I think those data provide support to that, and provide an argument for delivering consolidation radiotherapy, if you like, for patients who have residual disease in their chest. There is additional toxicity from the treatment — the patients are pretty bashed up after their chemotherapy, so I think it’s a sort of individual discussion that we have with patients.

Dr. West:  And your thoughts?

Dr. Horn:  So, were doing the same. In the patients who tolerated chemotherapy well, and are doing well after chemotherapy, and had either bulky disease, or have residual disease, we will send them to discuss the thoracic radiation with the radiation oncology folks.