Guideline sources The following summarized guidelines for the evaluation and management of small cell lung cancer (SCLC) are prepared by our editorial team based on guidelines from the European Society of Medical Oncology (ESMO 2022; 2021), the American Association for Thoracic Surgery (AATS/ESTS 2022), the American College of Chest Physicians (ACCP 2021; 2013), the U.S. Preventive Services Task Force (USPSTF 2021), the Spanish Association of Medical Oncology (SEOM 2020), the American Society for Radiation Oncology (ASTRO 2020), and the American Society of Clinical Oncology (ASCO 2020). 1 2 3 4 5 6 7 8 9 Calculator Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s Manchest https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 1/13 6/24/23, 3:14 PM Small cell lung cancer Pathway Guidelines 1. Screening and diagnosis Indications for screening, low-dose CT: As per ACCP 2021 guidelines, obtain annual screening for lung cancer with low-dose CT in asymptomatic individuals aged 55-77 years with a 30 pack-year smoking history and either continuing to smoke or have quit within the past 15 years. B Show 3 more As per USPSTF 2021 guidelines: Obtain annual screening for lung cancer with low-dose CT in individuals aged 50-80 years with a 20 pack-year smoking history and either currently being a smoker or having quit within the past 15 years. B Discontinue screening once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. B Indications for screening (other modalities): Do not obtain a CXR once or at regular intervals for lung cancer screening in patients at risk for developing lung cancer. D Avoid obtaining sputum cytology at regular intervals for lung cancer screening in patients at risk for developing lung cancer. D Indications for screening (requirements for screening programs): consider developing strategies to determine whether patients have symptoms suggesting the presence of lung cancer so that symptomatic patients do not enter screening programs but instead receive appropriate diagnostic testing, regardless of whether the symptomatic patient meets screening eligibility criteria. Show 8 more 2. Classification and risk stratification Staging: As per ESMO 2021 guidelines: Diagnose SCLC according to the WHO criteria. B Stage SCLC according to the AJCC/International Union Against Cancer TNM 8th edition. B As per ACCP 2013 guidelines, classify the tumor stage Use the Veterans Administration system (limited-stage, extensive-stage) and the AJCC/International Union Against Cancer TNM system for staging SCLCs. B https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 2/13 6/24/23, 3:14 PM Small cell lung cancer Pathway 3. Diagnostic investigations Initial evaluation: As per ESMO 2021 guidelines: Elicit smoking history, perform a physical examination, and obtain a CBC, liver enzymes, sodium, potassium, calcium, glucose, LDH, creatinine, and lung function test (if localized disease) in the initial evaluation of patients with SCLC. B Assess for potential autoimmune-mediated paraneoplastic neurological symptoms and detect paraneoplastic disorders in patients eligible for immunotherapy. B As per ACCP 2013 guidelines: Obtain a thorough evaluation to provide an initial clinical assessment of tumor stage in patients with suspected or known lung cancer. B Elicit a medical history, perform a physical examination, and obtain a CBC and comprehensive chemistry panel with renal and hepatic function tests for staging evaluation in patients with suspected or known SCLC. B Imaging for staging: As per ESMO 2021 guidelines, obtain contrast-enhanced chest and abdomen CT for staging of patients with SCLC. B Show 3 more As per SEOM 2020 guidelines: Obtain FDG-positron emission tomography-CT in patients with localized disease. B Obtain MRI (preferred) or CT (with IV contrast) for brain imaging. B As per ACCP 2013 guidelines, obtain contrast-enhanced chest and abdomen CT or chest CT extending through the liver and adrenal glands, brain MRI or CT, and bone scan for staging evaluation in patients with suspected or known SCLC. B Show 6 more 4. Diagnostic procedures Biopsy and histopathology, primary tumor: As per ESMO 2021 guidelines: Prefer histology over cytology for pathological diagnosis. B Insufficient evidence to support the use of a predictive biomarker. Do not obtain PD-L1 and tumor mutational burden testing in routine clinical practice. I As per ACCP 2013 guidelines, report the histologic type, tumor size and location, tumor grade (if appropriate), lymphovascular invasion, pleural involvement, surgical margins, and status and location of lymph nodes by station during the pathological assessment. B Show 4 more Biopsy and histopathology (mediastinum): obtain invasive staging of the mediastinum over staging by imaging alone in patients with discrete mediastinal lymph node enlargement (and no https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 3/13 6/24/23, 3:14 PM Small cell lung cancer Pathway distant metastases) with or without positron emission tomography uptake in mediastinal nodes. B Show 6 more Biopsy and histopathology, metastases: As per ESMO 2021 guidelines, perform bone marrow aspiration and biopsy in patients with limited-stage disease with abnormal blood counts suggesting bone marrow involvement. B As per ACCP 2013 guidelines, perform tissue sampling to pathologically confirm the clinical stage before deciding on treatment in patients with an imaging finding (for example, by positron emission tomography) suggestive of metastasis. B 5. Medical management General principles: Consider ensuring timely and efficient delivery of care in patients with known or suspected lung cancer. C Consider using a multidisciplinary team approach in patients with lung cancer requiring multimodality therapy. C Management of bronchial intraepithelial neoplasia: consider performing standard white light bronchoscopy to exclude an endobronchial lesion in patients with severe dysplasia or carcinoma in situ in sputum cytology with chest imaging showing no localizing abnormality. C Show 4 more Management of limited-stage disease, surgical resection: As per ESMO 2021 guidelines, consider performing surgery in patients with clinical stage I-II (cT1-2N0) SCLC within a multimodal treatment concept and following a multidisciplinary board decision. C Show 3 more As per SEOM 2020 guidelines, perform lobectomy with a systematic lymph node dissection as the preferred surgical procedure after mediastinal staging in patients with limited-stage (stage I- IIA, T1-2N0M0) SCLC. B As per ACCP 2013 guidelines, consider performing surgical resection in patients with clinical stage I SCLC after a thorough evaluation for distant metastases and invasive mediastinal stage evaluation. C Management of limited-stage disease, adjuvant chemoradiotherapy: As per ESMO 2021 guidelines, offer adjuvant chemotherapy after surgical resection of SCLC. B Show 3 more As per ASTRO 2020 guidelines: Consider offering postoperative radiotherapy in patients with limited-stage SCLC and R1 or R2 resection. E https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 4/13 6/24/23, 3:14 PM Small cell lung cancer Pathway Consider offering postoperative mediastinal radiotherapy in patients with clinically node- negative and pathologically N2-positive limited-stage SCLC. E As per SEOM 2020 guidelines: Offer adjuvant chemotherapy in patients with N0 disease. B Offer adjuvant chemotherapy and thoracic radiotherapy in patients with pN1 or pN2 disease. B As per ACCP 2013 guidelines, offer adjuvant platinum-based chemotherapy after curative-intent surgical resection in patients with stage I SCLC. B Management of limited-stage disease, concurrent chemoradiotherapy: As per ESMO 2021 guidelines, offer concurrent chemotherapy and thoracic radiotherapy in patients with T1-4N0-3M0 tumors and a good performance status (0-1). A Show 5 more As per ASTRO 2020 guidelines, offer thoracic radiotherapy in patients with limited-stage SCLC able to tolerate definitive therapy. A Show 3 more As per SEOM 2020 guidelines: Offer stereotactic body radiotherapy as an alternative in patients with stage I-IIA SCLC with surgical contraindication or refusing surgery. B Offer 4 cycles of adjuvant chemotherapy after completion of stereotactic body radiotherapy. B Offer concurrent chemotherapy (4-6 cycles of cisplatin plus etoposide; or carboplatin instead of cisplatin when contraindicated) and thoracic radiotherapy (45 Gy with twice-daily fraction or 60-70 Gy with once-daily fraction; initiated as early as with the first or second course of chemotherapy) in patients with limited-stage IIB-IIIC SCLC. A As per ACCP 2013 guidelines: Offer early chemoradiotherapy (accelerated hyperfractionated radiotherapy concurrently with platinum-based chemotherapy) in patients with limited-stage SCLC. B Offer 4-6 cycles of platinum-based chemotherapy with either cisplatin or carboplatin plus either etoposide or irinotecan over other chemotherapy regimens. A Management of limited-stage disease (technical considerations for radiotherapy): administer twice-daily radiotherapy in 150 cGy fractions to 4,500 cGy in patients with limited-stage SCLC. A Show 4 more Management of limited-stage disease (elderly patients): Consider offering platinum-based chemotherapy plus thoracic radiotherapy, with close attention to the management of treatment-related toxicity, in elderly patients with limited-stage SCLC and good performance status (ECOG 0-2). C Consider offering chemotherapy in elderly patients with SCLC and poor performance status due to SCLC. C Management of limited-stage disease, prophylactic cranial irradiation: https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 5/13 6/24/23, 3:14 PM Small cell lung cancer Pathway As per ESMO 2021 guidelines, insufficient evidence to recommend prophylactic cranial irradiation in patients with stage I-II SCLC, patients aged > 70 years, and frail patients. Obtain shared decision-making in such cases. I Show 2 more As per ASTRO 2020 guidelines, obtain brain MRI for restaging to guide decision-making regarding prophylactic cranial irradiation in patients with SCLC responding to initial therapy. B Show 4 more As per SEOM 2020 guidelines: Do not offer prophylactic cranial irradiation in patients with T1-2N0M0 disease. Offer prophylactic cranial irradiation (25 Gy) in patients with limited-stage IIB-IIIC SCLC without progression after chemotherapy and thoracic radiotherapy. A As per ACCP 2013 guidelines, offer prophylactic cranial irradiation in patients with limited-stage SCLC achieving a complete or partial response to initial therapy. B Management of extensive-stage disease, systemic therapy: As per ESMO 2021 guidelines, consider offering an anti-PD-L1 inhibitor (atezolizumab or durvalumab) in combination with 4 cycles of a platinum and etoposide in all patients with treatment-na ve extensive-stage SCLC, a performance status of 0-1, and no contraindications for immunotherapy. B Show 3 more As per SEOM 2020 guidelines, offer platinum plus etoposide with immunotherapy as first-line therapy in patients with extensive-stage (stage IV, T1-4 N1-3 M1a, b, c) SCLC: 4 cycles of carboplatin, etoposide, and atezolizumab followed by maintenance atezolizumab until progression 4 cycles of durvalumab, carboplatin/cisplatin, and etoposide followed by maintenance with durvalumab until progression. A Show 2 more As per ACCP 2013 guidelines, offer 4-6 cycles of platinum-based chemotherapy with either cisplatin or carboplatin plus either etoposide or irinotecan in patients with extensive-stage SCLC. A Management of extensive-stage disease, consolidative radiotherapy: As per ESMO 2021 guidelines: Offer radiotherapy to the residual primary tumor and lymph nodes (30 Gy/10 fractions) in patients with extensive-stage SCLC achieving a response after chemotherapy and having a performance status of 0-2. B Insufficient evidence to recommend consolidation thoracic radiotherapy in combination with immunotherapy in patients with extensive-stage SCLC. Consider offering treatment following a shared decision-making process. I As per ASTRO 2020 guidelines, offer thoracic radiotherapy in patients with extensive-stage SCLC responding to chemotherapy alone but having a residual tumor in the thorax. A Show 3 more https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 6/13 6/24/23, 3:14 PM Small cell lung cancer Pathway As per SEOM 2020 guidelines, consider offering consolidative thoracic radiotherapy in selected patients achieving a complete or near complete response after chemotherapy. B As per ACCP 2013 guidelines, consider offering a course of consolidative thoracic radiotherapy in patients with extensive-stage SCLC achieving a complete response outside the chest and complete or partial response in the chest after chemotherapy. C Management of extensive-stage disease (elderly patients): Consider offering carboplatin-based chemotherapy in elderly patients with extensive-stage SCLC and good performance status (ECOG 0-2). B Consider offering in elderly patients with SCLC and poor performance status due to SCLC. C Management of extensive-stage disease, prophylactic cranial irradiation: As per ESMO 2021 guidelines, insufficient evidence to recommend prophylactic cranial irradiation in patients with extensive-stage SCLC. Consider offering treatment following a shared decision-making process. I Show 3 more As per ASTRO 2020 guidelines: Consult with a radiation oncologist to enhance shared decision-making regarding prophylactic cranial irradiation versus MRI surveillance (taking into account patient- and disease-specific characteristics) in patients with extensive-stage SCLC responding to chemotherapy. B Administer 2,500 cGy in 10 fractions or 2,000 cGy in 5 fractions in patients with extensive- stage SCLC undergoing prophylactic cranial irradiation. B As per SEOM 2020 guidelines, assess the need for prophylactic cranial irradiation (25 Gy) in patients with extended-stage SCLC with good performance status achieving a response. B As per ACCP 2013 guidelines, offer prophylactic cranial irradiation in patients with extensive- stage SCLC achieving a complete or partial response to initial therapy. B Management of extensive-stage disease (palliative care): consider offering early palliative care combined with standard oncology care in patients with stage IV lung cancer and/or a high symptom burden. C Show 2 more Management of relapsed/refractory disease: As per ESMO 2021 guidelines, offer participation in a clinical trial or best supportive care in patients with platinum-refractory SCLC. B Show 4 more As per SEOM 2020 guidelines, offer participation in a clinical trial in patients progressing during treatment or less than 3 months. B Show 2 more As per ACCP 2013 guidelines, offer second-line, single agent-chemotherapy in patients with relapsed or refractory SCLC. B Symptomatic management (pain control): obtain a thorough assessment of patients with lung cancer experiencing chronic pain. B https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 7/13 6/24/23, 3:14 PM Small cell lung cancer Pathway Show 9 more Symptomatic management (cough): obtain evaluation for other treatable causes of cough, in addition to cancer-related etiologies, in all patients with lung cancer and troublesome cough. B Show 2 more Symptomatic management, hemoptysis: As per ESMO 2022 guidelines, consider performing an endoscopy (endobronchial or by guiding endovascular embolization) for the diagnosis and treatment of hemoptysis. C Show 2 more As per ACCP 2013 guidelines: Secure the airway with a single-lumen endotracheal tube in patients with lung cancer and large-volume hemoptysis. Perform bronchoscopy to identify the source of bleeding, followed by endobronchial management options such as argon plasma coagulation, Nd-YAG laser, and electrocautery for visible central airway lesions. B Perform bronchoscopy to identify the source of bleeding in patients with lung cancer and non- large-volume hemoptysis. Offer endobronchial management options for visible central airway lesions. Offer EBRT for distal or parenchymal lesions. B Symptomatic management, airway obstruction: As per ESMO 2022 guidelines, offer EBRT in patients with hemoptysis and symptomatic airway obstruction. B Show 2 more As per ACCP 2013 guidelines, perform therapeutic bronchoscopy with mechanical debridement, brachytherapy, tumor ablation, or airway stent placement to improve dyspnea, cough, hemoptysis, and overall quality of life in patients with inoperable disease and symptomatic airway obstruction. B Symptomatic management, pleural effusion: As per ESMO 2022 guidelines: Perform talc pleurodesis to improve dyspnea in patients with persisting or recurrent pleural effusions. Consider performing thoracoscopic poudrage over injection of talc slurry in patients with primary lung cancer. B Consider performing placement of an indwelling pleural catheter or talc poudrage for the management of recurrent malignant pleural effusions. C As per ACCP 2013 guidelines, perform tunneled pleural catheter placement or chemical pleurodesis with talc in patients with symptomatic recurrent malignant pleural effusion with documented re-expandable lung. B Show 3 more Symptomatic management (trapped lung): perform indwelling pleural catheter placement or pleuroperitoneal shunting to provide symptomatic relief in patients with a trapped lung by a thickened visceral pleural peel. B Symptomatic management (tracheoesophageal fistulas): perform double stenting of the esophagus and airway or esophageal stenting with self-expanding metallic stents in patients with https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 8/13 6/24/23, 3:14 PM Small cell lung cancer Pathway tracheoesophageal fistulas. B Symptomatic management, superior vena cava syndrome: As per ESMO 2022 guidelines, consider offering radiotherapy to achieve symptom control in patients with vena cava syndrome. C As per ACCP 2013 guidelines, obtain histologic or cytologic methods to confirm the definitive diagnosis of lung cancer before initiating treatment in patients with superior vena cava obstruction from suspected lung cancer. B Show 2 more Symptomatic management, neurologic symptoms: As per ESMO 2022 guidelines, consider offering radiotherapy to achieve symptom control in patients with soft tissue or neural invasion. C As per ACCP 2013 guidelines, administer dexamethasone at 16 mg/day during definitive therapy in patients with symptomatic brain metastases, and taper the dose as allowed by neurologic symptoms. B Show 3 more Symptomatic management, spinal cord compression: As per ESMO 2022 guidelines, offer early radiotherapy to relieve neurological symptoms from spinal cord compression. B As per ACCP 2013 guidelines, obtain MRI (sagittal T1-weighted) of the entire spine in patients with new-onset back pain. B Show 2 more Symptomatic management, bone symptoms: As per ESMO 2022 guidelines, consider offering radiotherapy to achieve symptom control in patients with painful chest wall disease and bone metastasis. C As per ACCP 2013 guidelines, offer external radiotherapy for pain relief in patients with pain due to bone metastases. A Show 3 more Symptomatic management (psychological symptoms): obtain a comprehensive biopsychosocial assessment soon after the diagnosis of lung cancer and at key transition points (completion of treatment, disease progression, and new symptom onset) thereafter for the remainder of life. B Show 8 more 6. Nonpharmacologic interventions Smoking cessation: As per ESMO 2021 guidelines, provide smoking cessation counseling as the occurrence of second malignancies, particularly if smoking is continued, is of concern in lung cancer survivors. B https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 9/13 6/24/23, 3:14 PM Small cell lung cancer Pathway As per ACCP 2013 guidelines, offer perioperative cessation pharmacotherapy, ideally initiated in the preoperative period, to improve abstinence rates in patients with lung cancer undergoing surgery. B Consider offering cessation counseling alone if pharmacotherapy is contraindicated or refused. B Initiate counseling and pharmacotherapy at the outset of surgical intervention in patients attempting cessation in conjunction with surgical interventions. B Show 2 more Alternative and complementary therapies: ask all patients with lung cancer about their interest in and usage of complementary therapies. Counsel on the benefits and risks of those therapies should be provided. B Show 8 more 7. Perioperative care Preoperative cardiorespiratory assessment: obtain an assessment by a multidisciplinary team (including a thoracic surgeon specializing in lung cancer, a medical oncologist, a radiation oncologist, and a pulmonologist) in patients with lung cancer planned for curative surgical resection. Obtain a full evaluation in elderly patients with lung cancer planned for curative surgical resection, regardless of age. B Show 11 more Perioperative thromboprophylaxis (lobectomy/segmentectomy): consider administering parenteral anticoagulation with subcutaneous LMWH or UFH for VTE prevention in patients undergoing lobectomy or segmentectomy. C Consider preferring LMWH over UFH. C Show 7 more Perioperative thromboprophylaxis (pneumonectomy): consider administering parenteral anticoagulation with subcutaneous LMWH or UFH for VTE prevention in patients undergoing pneumonectomy or extended lung resection. C Consider preferring LMWH over UFH. C Show 6 more 8. Specific circumstances Patients with Pancoast tumor (evaluation): obtain a tissue diagnosis before initiating treatment in patients with a Pancoast tumor. B Show 2 more Patients with Pancoast tumor (neoadjuvant therapy): consider offering preoperative concurrent chemoradiotherapy before surgical resection in patients with a potentially resectable Pancoast tumor (and good performance status). C Patients with Pancoast tumor (surgical resection): Make every effort to achieve complete resection in patients undergoing resection of a Pancoast tumor. B https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 10/13 6/24/23, 3:14 PM Small cell lung cancer Pathway Consider performing lobectomy (instead of a non-anatomic wedge resection) and resection of chest wall structures in patients undergoing resection of a Pancoast tumor. C Patients with Pancoast tumor (definitive and palliative therapy): Consider offering definitive concurrent chemotherapy and radiotherapy in patients with an unresectable, non-metastatic Pancoast tumor with good performance status. C Consider offering palliative radiotherapy in patients with a Pancoast tumor ineligible for curative- intent treatment. C Patients with additional pulmoary nodules (same lobe): Do not obtain further diagnostic workup of the additional nodule in patients with suspected or proven lung cancer and an additional (suspected) tumor nodule within the same lobe. D Obtain an evaluation of extrathoracic metastases and confirmation of the mediastinal node status as dictated by the primary lung cancer alone and not modified due to the presence of the additional lesion in patients with an additional (suspected) tumor nodule within the same lobe as a suspected or proven primary lung cancer. B Patients with additional pulmoary nodules (ipsilateral different lobe): exclude the possibility that an ipsilateral different lobe nodule represents a benign lesion or synchronous primary lung cancer in patients with suspected or proven lung cancer, taking into account clinical, radiologic, and tumor cytologic/histologic features (if available). B Show 2 more Patients with additional pulmoary nodules (contralateral lobe): consider obtaining an evaluation of extrathoracic metastases (by positron emission tomography and brain MRI/CT) and invasive evaluation to rule out mediastinal node involvement in patients with a contralateral lobe tumor nodule. C Patients with multifocal lung cancer (evaluation): Consider classifying multiple lesions at least partially ground glass and suspected to be malignant as multifocal lung cancer. C Avoid obtaining routine distant and mediastinal staging in patients with suspected or proven multifocal lung cancer with a negative clinical evaluation and normal mediastinum by CT. D Patients with multifocal lung cancer (management): Consider offering curative-intent treatment in patients with suspected or proven multifocal lung cancer. C Consider performing sublobar resection of all lesions suspected of being malignant, if feasible, in patients with suspected or proven multifocal lung cancer. C Patients with second primary lung cancer: Consider identifying two foci typical of primary lung cancer (either proven or suspected, i.e., solid, spiculated masses) as second primary lung cancers (either synchronous or metachronous) based on the judgment of a multidisciplinary team, taking into account clinical, radiologic, and tumor cytologic/histologic features (if available). C Consider performing resection of each lesion in patients (not suspected of having a second focus of cancer) found to have a second cancer in a different lobe intraoperatively, provided the https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 11/13 6/24/23, 3:14 PM Small cell lung cancer Pathway patient has an adequate pulmonary reserve and there is no N2 nodal involvement. C 9. Preventative measures Smoking cessation: As per ACCP 2021 guidelines, offer evidence-based tobacco cessation treatment in current smokers undergoing low-dose CT screening. B As per ACCP 2013 guidelines: Provide counseling and offer pharmacotherapy for smoking cessation in current smokers undergoing low-dose CT screening. B Offer intensive cessation interventions in current smokers with demonstrated smoking-related pulmonary disease. B Diet: Consider advising a diet rich in non-starchy vegetables and fruits to reduce the risk of lung cancer in individuals at risk of developing lung cancer. C Consider advising to limit the consumption of large amounts of red meat and processed meat to reduce the risk of lung cancer in individuals at risk of developing lung cancer. C Chemoprevention: Do not use the following agents for primary, secondary, or tertiary prevention of lung cancer in individuals at risk for lung cancer or in patients with a history of lung cancer: -carotene vitamin E retinoids N-acetylcysteine and isotretinoin. D Show 2 more 10. Follow-up and surveillance Surveillance after curative-intent therapy: As per ESMO 2021 guidelines, obtain CT every 2-3 months in patients with extensive-stage disease potentially qualifying for further treatments. B Show 3 more As per ASCO 2020 guidelines, obtain surveillance imaging for recurrence every 6 months for 2 years after definitive curative-intent therapy. B Obtain surveillance imaging for the detection of new primary lung cancers annually after the first 2 years. B Show 5 more As per SEOM 2020 guidelines: Obtain CT every 3 months in the first year, every 6 months in years 2-3, and then annually in patients with limited-stage disease. B https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 12/13 6/24/23, 3:14 PM Small cell lung cancer Pathway Obtain CT every 2 months in the first year, every 3 months in years 2-3, every 6 months in years 4-5, and then annually in patients with extensive stage disease. B As per ACCP 2013 guidelines, avoid obtaining surveillance biomarker testing (outside of clinical trials) in patients with SCLC treated with curative-intent therapy. D References 1. A M C Dingemans, M Fr h, A Ardizzoni et al. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jul;32 7 839 853. Open 2. M D mine, T Moran, D Isla et al. SEOM clinical guidelines for the treatment of small-cell lung cancer SCLC 2019 . Clin Transl Oncol. 2020 Feb;22 2 245 255. Open 3. Frank C Detterbeck, Sandra Zelman Lewis, Rebecca Diekemper et al. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143 5 Suppl):7S 37S. Open 4. L E Hendriks, K M Kerr, J Menis et al. Non-oncogene-addicted metastatic non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023 Jan 17;S0923 7534 22 04785 8. Open 5. Charles B Simone nd, Jeffrey A Bogart, Alvin R Cabrera et al. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2020 May-Jun;10 3 158 173. Open 6. Peter J Mazzone, Gerard A Silvestri, Lesley H Souter et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160 5):e427-e494. Open 7. Yaron Shargall, Wojtek Wiercioch, Alessandro Brunelli et al. Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer- associated venous thromboembolism in thoracic surgery. Eur J Cardiothorac Surg. 2022 Dec 2;63 1):ezac488. Open 8. US Preventive Services Task Force, Alex H Krist, Karina W Davidson et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325 10 962 970. Open 9. Bryan J Schneider, Nofisat Ismaila, Joachim Aerts et al. Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO Guideline. J Clin Oncol. 2020 Mar 1;38 7 753 766. Open 10. Lang Huang, Jian-Guo Zhou, Wen-Xiu Yao et al. Systematic review and meta-analysis of the efficacy of serum neuron-specific enolase for early small cell lung cancer screening. Oncotarget. 2017 May 11;8 38 64358 64372. Open 11. I Maestu, M Pastor, J G mez-Codina et al. Pretreatment prognostic factors for survival in small-cell lung cancer: a new prognostic index and validation of three known prognostic indices on 341 patients. Ann Oncol. 1997 Jun;8 6 547 53. Open https://web.pathway.md/diseases/rec5PjOmWwIfE6mM1 13/13