Review Note

a. What are the options for radiation therapy dose fractionation schedules in the curative intent management of this patient? Discuss the advantages and disadvantages of each option. (4)  

Fractionation options for limited stage small cell lung cancer: 
 
Turrisi 45Gy/30# 
- BD treatment, 9-10# per week 
Advantage:   
- strongest evidence to support use in randomised evidence 
- finish within shorter time, which is advantageous for chemotherapy  
Disadvantage: 
- lack of established OAR dose constraints 
- BD treatment logistically difficult on patient, requiring 6hrs between treatments 
 
Standard fractionation 66/33# 
- 9-10# per fortnight 
Advantage: 
- established OAR data dose constraints 
- once daily treatment, easier logistically for patient 
Disadvantage: 
- failed to do show non-inferiority over Turrisi   [CONVERT] 
- longer treatment time to complete course, delays chemotherapy 
 
Hypofractionation 40Gy/15# 
- 9-10# per fortnight 
Advantage: 
- Once daily treatment, easier logistically for patient 
- shorter time to completion, less delay to chemotherapy  
- Ideal in the setting of a pandemic
Disadvantage: 
- lack of established OAR constraints 
- data supporting this regime is old