Background: Small cell lung cancer (SCLC) carries a dismal prognosis with a 5-year survival of about 10%. Progress in treatment of SCLC has been poor and overall survival of SCLC has remained stagnant since the late 1970s. Limited-stage SCLC (LS-SCLC) is defined as a tumor confined into one hemithorax with or without lymphadenopathies included in a single radiation field. LS-SCLC frequently metastasizes to the brain. The administration of preventive radiation to the brain, a process known as prophylactic cranial irradiation (PCI) has been the major change in the management of SCLC. There is currently a paucity of data on sites of metastasis of SCLC after PCI has been performed. We aim to describe the pattern of recurrence post-PCI in SCLC.
Methods: A retrospective chart review of all LS-SCLC (stages IA to IIIB) patients who presented to the Stratton Veteran Affairs Medical Center (SVAMC) between January 2006 and January 2017 was performed. Exclusion criteria included other types of lung cancer and stage IV SCLC.
Results: Of the 31 LS-SCLC patients, 12 received PCI. Reasons for not receiving PCI included rapid progression of the disease/metastasis to the brain (8), patient refusal (5), loss to follow-up (4) and existing co-morbidities/poor performance status (2). Of the 12 that received PCI, 8 patients had recurrences, with most recurrences affecting more than one organ. Sites of recurrences included: lung (6), liver (4), lymph nodes (3), bone (2), soft tissue (1).
Conclusions: Post-PCI, LS-SCLC is likely to recur at the site of the tumor itself or metastasize to the liver and lymph nodes. Given the rarity of SCLC presenting at the limited stage, larger scale studies are needed to further delineate the pattern of metastasis of SCLC.
