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1、NCCN org Version 2 2019 08 05 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Small Cell Lung Ca
2、ncer Version 2 2019 August 5 2019 Continue Gregory P Kalemkerian MD Chair University of Michigan Rogel Cancer Center Billy W Loo Jr MD PhD Vice Chair Stanford Cancer Institute Wallace Akerley MD Huntsman Cancer Institute at the University of Utah Albert Attia MD Vanderbilt Ingram Cancer Center Micha
3、el Bassetti MD University of Wisconsin Carbone Cancer Center Collin Blakely MD PhD UCSF Hellen Diller Family Comprehensive Cancer Center Yanis Boumber MD PhD Fox Chase Cancer Center Alberto Chiappori MD Moffitt Cancer Center Thomas A D Amico MD Duke Cancer Institute Roy Decker MD PhD Yale Cancer Cen
4、ter Smilow Cancer Hospital M Chris Dobelbower MD PhD University of Alabama at Birmingham Comprehensive Cancer Center Afshin Dowlati MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Robert J Downey MD Memorial Sloan Kettering
5、 Cancer Center Anna Farago MD PhD Massachusetts General Hospital Cancer Center Charles Florsheim Patient Advocate Apar Kishor P Ganti MD Fred T1 4 N1 3 M0 Also for SCL 4 SCL 3 Testing Results option was split into two different pathways Medically inoperable or decision made not to pursue surgical re
6、section and Pathologic mediastinal staging positive Initial Treatment Medically inoperable or decision made not to pursue surgical resection SABR or Systemic therapy concurrent RT See SCL 4 was added Adjuvant Treatment Medically inoperable or decision made not to pursue surgical resection Systemic t
7、herapy was added SCL 6 Response Assessment Following Initial Therapy Bullet 2 was revised Brain MRI preferred or CT with contrast if prophylactic cranial irradiation PCI to be given Chest x ray optional was removed Adjuvant Treatment Extensive stage bullet was split into two statements Consider PCI
8、or MRI brain surveillance and Consider thoracic RT Surveillance Bullet 1 was added Provide Survivorship Care Plan after completion of initial therapy Bullet 3 was revised If PCI not given then MRI preferred or CT brain with contrast every 3 4 mo during y 1 2 was changed to MRI preferred or CT brain
9、with contrast every 3 4 months during y 1 then every 6 months during y 2 regardless of PCI status Footnote t was revised by adding the second sentence Increased cognitive decline after PCI has been observed in older adults 60 years in prospective trials the risks and benefits of PCI versus close sur
10、veillance should be carefully discussed with these patients SCL 7 Progressive Disease Continued Updates in Version 2 2019 of the NCCN Guidelines for Small Cell Lung Cancer from Version 1 2019 include MS 1 The discussion section was updated to reflect the changes in the algorithm NCCN Guidelines Vers
11、ion 2 2019 Small Cell Lung Cancer Version 2 2019 08 05 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Prin
12、ted by Maria Chen on 8 6 2019 9 28 21 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved UPDATES Subsequent Therapy Palliative Therapy statement revised after response Continue until progression two cycles beyond best r
13、esponse or Progression or development of unacceptable toxicity SCL A 2 of 2 Signs and symptoms of paraneoplastic syndromes Neurologic First sub bullet was added If paraneoplastic neurologic syndrome is suspected consider obtaining comprehensive paraneoplastic antibody panel SCL B Pathologic Evaluati
14、on Bullet 3 was revised poorly differentiated neuroendocrine tumor carcinoma SCL C Principles of Surgical Resection Bullet 1 was revised Stage I IIA SCLC Bullet 2 was revised from Patients with disease in excess of T1 2 N0 do not benefit from surgery to Patients most likely to benefit from surgery a
15、re those with SCLC that is clinical stage I IIA T1 2 N0 M0 after standard staging evaluation including CT of the chest and upper abdomen brain imaging and PET CT imaging Sub bullet 2 was added For patients undergoing definitive surgical resection the preferred operation is lobectomy with mediastinal
16、 lymph node dissection Bullet 3 and sub bullets were condensed from Patients with SCLC that is clinical stage I T1 2 N0 after standard staging evaluation including CT of the chest and upper abdomen brain imaging and PET CT imaging may be considered for surgical resection and Prior to resection all patients should undergo mediastinoscopy or other surgical mediastinal staging to rule out occult nodal disease This may also include an endoscopic staging procedure to Patients who undergo complete res
