Lung Cancer179(2023)107166Contents lists available at ScienceDirectLung CancerELSEVIERjournal homepage:www.elsevier.com/locate/lungcanUse of radiation therapy among patients with Extensive-stage Small-celllung cancer receiving Immunotherapy:Canadianconsensus recommendationsAlexander Sun,,Bassam Abdulkarim,Normand Blais,Jonathan GreenlanddAlexander V.Louie,Barbara Melosky',Devin Schellenberg,Stephanie Snow Geoffrey Liu'Princess Margret Cancer Centre,700 Unlversity Avee,Toronto,ON M5G 1Z5,CanadaMcGill University Health Centre,McGill Universiry,1001 Decarie Boulevard MontreaL QC H4A 3J1,CanadaCenre Hospitalier de I'Untversie de Montrinl,University of Montrinl,1051 Rue Sanguine,Montredl,QC H2X 3E4,Canadad Eastem Health,300 Prince Philip Drive,S.John's,NI.A1B 3V6,CanodaSunrybrook Health Sclences Centre,2075 Bayview Avenue,Toronto,ON M4N 3M5,CanadaBC Cancer-Vancouver Centre,600 W 10th Avere,Vancouver,BC V5Z 4E6,Canoda8 BC Cancer-Sumey Centre,13750 96 Avenue Sumey,BC V3V 172,CanodaQEII Health Sciences Centre,Dalhousie University,5788 University Avenue Halyfax NS B3H 1V8,CanadaPrincess Margaret Cancer Centre University Health Network,610 University Avenue,Toron,ON M5G 2M9,CanodaARTICLE INFOABSTRACTKeywords:Objectives:Thoracic radiation therapy (TRT)and prophylactic cranial irradiation(PCD)are commonly used in theExtensive-stage small-cell lung cancermanagement of extensive-stage small-cell lung cancer (ES-SCLC);however,Phase IlI trials of first-line immu-Thoracie rad iation therapynotherapy often excluded these options.Guidance is needed regarding appropriate use ofTRT,PCL,and magneticProphylactic cranial irradiationImmunotherapyresonance imaging (MRD)surveillance while new data are awaited.Consensus recommendationsMaterials and methods In two web-based meetings,a pan-Canadian expert working group of five radiation on-Guidelinescologists and four medical oncologists addressed eight clinical questions regarding use of radiation therapy (RT)and MRI surveillance among patients with ES-SCLC receiving immunotherapy.A targeted literature review wasconducted using PubMed and conference proceedings to identify recent(January 2019-April 2022)publicationsin this setting.Fifteen recommendations were developed;online voting was conducted to gauge agreement witheach recommendation.Results After considering recently available evidence across lung cancer populations and clinical experience,theexperts recommended that all patients with a response to chemo-immunotherapy,good performance status(PS)and limited metastases be considered for consolidation TRT (e.g.,30 Gy in 10 fractions).When consideredappropriate after multidisciplinary team discussion,TRT can be initiated during maintenance immunotherapy.All patients who respond to concurrent chemo-immunotherapy should undergo restaging with brain MRI toguide decision-making regarding PCI versus MRI surveillance alone.MRI surveillance should be conducted fortwo years after response to initial therapy.PCI (e.g.,25 Gy in 10 f
