SBRT Treatment of Metachronous Small-Cell and Non-Small-Cell Lung Carcinomas in a Patient with Severe COPD

Abstract

Stereotactic body radiotherapy (SBRT) has not been widely employed in the treatment of limited-stage (LS) small-cell lung cancer (SCLC), although SBRT finds particular utility in patients medically unfit to undergo surgical resection or radiotherapy with conventional fields. The authors present the case of a 61-year-old female smoker with severe chronic obstructive pulmonary disease (COPD), diagnosed incidentally with LS-SCLC. Concurrent chemoradiotherapy was contraindicated by her poor pulmonary function, and she was treated radically with four cycles of cisplatin and etoposide chemotherapy. This was followed by prophylactic cranial irradiation and consolidative SBRT (48 Gy in 4 fractions) to the residual tumour, which achieved a complete clinical response. Fifteen months following the patient’s initial diagnosis, a metachronous Stage IA contralateral non-small cell lung cancer (NSCLC) was incidentally diagnosed and was treated with SBRT (48 Gy in 4 fractions). Although studies have established that the incidence of a second lung cancer is higher in patients with previous SCLC, this case is unique in that both primaries were treated with SBRT.

Pattern of Imaging after Lung Cancer Resection. 1992–2005

“…Conflicting data on the use of surveillance chest imaging stem from debate over detection of recurrence versus second primary lung cancer and synchronous versus metachronous primary lesions. The growing use of stereotactic body radiation therapy in the treatment of recurrence (34)(35)(36) and/or metachronous cancers (37) and second primary lung cancers (38) may help redefine the role of surveillance in patients with lung cancer.…”