Small cell lung cancer   

Is there objective evidence demonstrating a benefit of consolidative durvalumab or prophylactic cranial irradiation in patients with stage I small cel...

What factors prompt you to offer adjuvant RT? What would be included in your field? Is elective mediastinal RT still used? Assume initial imaging was ...

Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction ...

What clinical factors do you take into consideration? Would you recommend chemo-immunotherapy regimens for a fit patient who relapses at 6 mos post-t...

Does tumor size, age, or performance status play a role in your decision-making?

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Would the timing of the relapse (eg within 6 months) impact your decision making?

In elderly patients (>70-75) with a good performance status, does the risk of neurocognitive decline outweigh the benefit of PCI?

If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?

Would you offer topotecan, lurbinectedin, or another agent given the CNS progression as well? 

Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...

Patient is <60 years old 

Are you routinely performing molecular sequencing? Would you modify your treatment approach in first or later lines based on PDL1 status?

If so, do you allow a period of "washout" between immunotherapy and radiation?

How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospi...

Would you differentiate between patients with measurable disease vs NED?  Are there specific data to guide us?

E.g. chemo/durvalumab vs chemo/atezolizumab?  

Would you treat the nodes with margin, the nodal group, or the whole untreated mediastinum?

What are the risks of infection with COVID-19 if using immunotherapy?  

If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?

Would the results effect your decision to offer PCI?

Would you consider adding atezolizumab to a cisplatin/irinotecan regimen, or cisplatin instead of carboplatin?

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

Does the T stage or location of malignancy affect your decision?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

Does your practice differ based on limited or extensive stage disease?

Has the publication of IMpower133 changed standard of care?

Would you repeat PET or is it adequate to change to CT surveillance? Although surveillance PET/CT is not recommended by NCCN guidelines, these are oft...

Or would you wait to start coincident with the start of cycle 2? If a shorter time from the start of any therapy to the end of radiation (SER) is sign...

Does the stage of the cancer affect this decision?

In a patient with newly diagnosed small cell lung cancer with disease limited only to the thorax would you treat with definitive chemoRT in the presen...