Three times sequential chemoradiotherapy for in-field relapse in a patient with limited disease small cell lung cancer; a Case Report.

Sherif Y. El Sharouni, Marnix J.A. Rasing J.A. Rasing, Rick A.J. Heyne, Franz M. Schramel


Background:A minority of small cell lung cancer patients show a late local relapse after curative chemoradiotherapy. When distant metastases are absent and the patient is in good clinical condition, a new curative treatment should be considered. Risk of relevant late toxicity is of concern when high dose reirradiation is given.

Case report:A 60-year- old woman showed a local relapse (T4N0-1M0) almost threeyears after sequential chemoradiotherapy treatment with a radiation dose of 13x3 Gy for stage T4N2M0 small cell lung cancer, located centrally in the left upper lobe. She receivedsequential chemoradiotherapy with a dose of 13x3 Gy, followed by a complete response. One year later she had a local relapse for the second time,stage IB disease. After chemotherapy, stereotactic body radiotherapy of 12x5 Gy was given to the location of the relapse. Till the present day, no treatment complications have been seen; she has a good physical condition and continued working untilher retirement.

Literature and conclusion: data of small cell lung cancer reirradiation are scarce. Thoracic reirradiation for lung cancer can improve survival in recurring disease.However, late toxicity such as massive bleeding is very likelywhen the tumoris centrally localized and when there is overlap of the radiation fields. Expected survival benefit together withsevere toxicity is contradictory and decisionmaking is important in a subgroup of patients. Cases like ours show the possibility of long-term survival without any late toxicity.

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