Small Cell Lung Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

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Abstract

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The “Summary of the Guidelines Updates” section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.

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Cancer Statistics, 2021

Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2021)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.

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Reduced lung-cancer mortality with low-dose computed tomographic screening.

(2011)

The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02). Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).

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The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.

William Travis, Elisabeth Brambilla, Andrew G Nicholson … (2015)

The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and

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Author and article information

Journal

Title: Journal of the National Comprehensive Cancer Network

Publisher: Harborside Press, LLC

ISSN (Print): 1540-1405

ISSN (Electronic): 1540-1413

Publication date Created: December 2021

Publication date (Print): December 2021

Volume: 19

Issue: 12

Pages: 1441-1464

Affiliations

[1 ]1Fred & Pamela Buffett Cancer Center;

[2 ]2Stanford Cancer Institute;

[3 ]3University of Wisconsin Carbone Cancer Center;

[4 ]4UCSF Helen Diller Family Comprehensive Cancer Center;

[5 ]5Yale Cancer Center/Smilow Cancer Hospital;

[6 ]6Duke Cancer Institute;

[7 ]7Abramson Cancer Center at the University of Pennsylvania;

[8 ]8Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

[9 ]9Memorial Sloan Kettering Cancer Center;

[10 ]10Fox Chase Cancer Center;

[11 ]11Patient Advocate;

[12 ]12UC San Diego Moores Cancer Center;

[13 ]13UCLA Jonsson Comprehensive Cancer Center;

[14 ]14The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

[15 ]15The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

[16 ]16Vanderbilt-Ingram Cancer Center;

[17 ]17UT Southwestern Simmons Comprehensive Cancer Center;

[18 ]18UC Davis Comprehensive Cancer Center;

[19 ]19O'Neal Comprehensive Cancer Center at UAB;

[20 ]20City of Hope National Medical Center;

[21 ]21Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

[22 ]22Mayo Clinic Cancer Center;

[23 ]23The University of Texas MD Anderson Cancer Center;

[24 ]24Roswell Park Comprehensive Cancer Center;

[25 ]25Huntsman Cancer Institute at the University of Utah;

[26 ]26University of Michigan Rogel Cancer Center;

[27 ]27University of Colorado Cancer Center;

[28 ]28Dana Farber/Brigham and Women's Cancer Center;

[29 ]29Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

[30 ]30Moffitt Cancer Center;

[31 ]31Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

[32 ]32National Comprehensive Cancer Network.

Article

DOI: 10.6004/jnccn.2021.0058

PubMed ID: 34902832

SO-VID: 3b8c1214-0b92-408c-9625-ab7d7f53c563

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Small Cell Lung Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

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Karger: Oncology

Most cited references 198

Cancer Statistics, 2021

Reduced lung-cancer mortality with low-dose computed tomographic screening.

The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.

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Cited by 91

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