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Featured Case Studies 2004, Volume 1, Number 5

Recurrent Metastatic Small Cell Lung Carcinoma

by > David Grisell, DO

Clinical problem

This 68-year-old man was diagnosed with limited stage small cell lung cancer in August 2002. He was treated with chemotherapy and radiotherapy to the chest and whole brain. A complete remission was achieved. In March 2004, he suffered a grand mal seizure and MR showed a single brain metastasis. There was no evidence of relapse outside the brain.

Treatment options

Historically, patients who develop brain metastases from lung carcinoma often die of neurologic complications. Patients with brain metastases from small cell lung carcinoma can present special treatment challenges since many of these patients have previously received whole brain radiotherapy. Repeat whole brain radiotherapy with reduced doses can provide short-term palliation, but permanent local control requires more aggressive local treatment with either conventional surgical excision or stereotactic radiosurgery. This patient was treated with stereotactic radiosurgery using a single dose of 16.00 Gy, which he tolerated without side effects or complications. Following MR 3 months later showed a 50% decrease in tumor size.

Figure 1. The recurrent tumor is targeted for radiotherapy treatment using dynamic conformal arc technology. The dose of radiation drops off rapidly at approximately 10% per millimeter away from the target volume.

Figure 2. MR scan done 3 months later shows a 50% reduction in tumor size. Further reduction is usually seen over the next 3 to 6 months.

Comments

Radiosurgery for brain metastases from lung cancer has a local control rate of approximately 80%. Local control of brain metastases alters the natural history of metastatic lung carcinoma, extending their survival and improving their neurologic quality of life.

References

• Serizawa T, Ono J, Iichi, T, et al. Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non-small carcinoma. J Neurosurg 97(5 Suppl):484-8, 2002
• Breneman JC, Warnick RE, Albright RE Jr, Kukiatinant N, Shaw J, Armin D, Tew J Jr. Stereotactic radiosurgery for the treatment of brain metastases. Results of a single institution series. Cancer 79(3):551-7, 1997.

How to refer

Because of the specific nature and complexity of the services we provide, patients must have a consultation with one of our physicians prior to being referred to the center. To schedule an appointment with one of our physicians, please contact Precision Radiotherapy at 513-475-7777.