Aggressive Palliation in Extensive Stage Small Cell Lung Cancer, Practice Guidelines versus Clinical Practice : A Case Report and Review of the Literature

Abstract EN

Small cell lung cancer (SCLC) constitutes approximately 16% of all primary lung cancers, with more than 35,000 new cases per year.

Two-thirds of patients present with extensive stage disease (ES-SCLC) due to a tendency to metastasize early.

Outcomes remain poor, with a median survival of approximately 10 months and a two-year overall survival of <10%.

Current recommendations call for combination chemotherapy alone in patients without localized symptoms.

Thoracic radiation therapy following a good clinical response is controversial.

We report on a patient with ES-SCLC that had an excellent response to chemotherapy and underwent whole brain radiotherapy for a known brain metastasis and consolidative radiotherapy to the thorax.

His latest follow-up demonstrates only a stable residual pulmonary nodule and no evidence of active metastatic disease.

ES-SCLC is a relatively common presentation with a variable burden of metastatic disease.

In the absence of randomized trials demonstrating the efficacy of thoracic radiation therapy, the community radiation oncologist is placed in a difficult position when addressing these patients, particularly those with otherwise good performance status and a good response to initial systemic chemotherapy.

More research in this area is sorely needed to help guide treatment recommendations.