open access

Vol 24, No 6 (2019)
Original research articles
Published online: 2019-11-01
Submitted: 2019-02-13
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First report of pulmonary large cell neuroendocrine carcinoma treated with stereotactic body radiation therapy

Shearwood McClelland, Gregory A. Durm, Thomas J. Birdas, Paul M. Musto, Tim Lautenschlaeger
DOI: 10.1016/j.rpor.2019.08.005
·
Rep Pract Oncol Radiother 2019;24(6):507-510.

open access

Vol 24, No 6 (2019)
Original research articles
Published online: 2019-11-01
Submitted: 2019-02-13

Abstract

Introduction

Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a very rare disease, comprising approximately 3% of lung cancers. Even for Stage I disease, recurrence after resection is common, with a poor five-year overall survival. We present the first report of stereotactic body radiotherapy (SBRT) for pulmonary LCNEC.

Methods

A 54-year-old woman with a left upper lobe pulmonary nodule underwent a wedge resection with thoracoscopic mediastinal lymph node dissection, revealing a 2.3cm pT1b N0 LCNEC. Approximately one year later, surveillance imaging demonstrated a new left upper lobe PET-avid nodule, resulting in completion left upper lobectomy revealing LCNEC, with 0/6 involved lymph nodes and negative staging studies. The patient subsequently chose surveillance over adjuvant chemotherapy; unfortunately 23 months later imaging revealed an enlarging 0.7cm nodule adjacent to the previous resection site, despite the patient remaining in good health (KPS=90). Subsequent restaging demonstrated no evidence of metastatic disease. Due to the morbidity of a third operation in this region, and based on the safety of SBRT for Stage I non small-cell lung cancer, the consensus decision from our thoracic oncology team was to proceed with SBRT as preferred management for presumptive second recurrence of LCNEC. The patient shortly thereafter underwent SBRT (50Gy in 10Gy/fraction) to this new nodule, 41 months following initial LCNEC diagnosis.

Results

Four months following SBRT, the patient remains in excellent clinical condition (KPS 90), with no evidence of disease spread on surveillance studies. The nodule itself demonstrated no evidence of growth following SBRT.

Conclusions

This first report of SBRT for pulmonary LCNEC demonstrates that SBRT is a feasible modality for this rare disease. A multidisciplinary thoracic oncology approach involving medical oncology, thoracic surgery, radiation oncology and pulmonology is strongly recommended to ensure proper patient selection for receipt of SBRT.

Abstract

Introduction

Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a very rare disease, comprising approximately 3% of lung cancers. Even for Stage I disease, recurrence after resection is common, with a poor five-year overall survival. We present the first report of stereotactic body radiotherapy (SBRT) for pulmonary LCNEC.

Methods

A 54-year-old woman with a left upper lobe pulmonary nodule underwent a wedge resection with thoracoscopic mediastinal lymph node dissection, revealing a 2.3cm pT1b N0 LCNEC. Approximately one year later, surveillance imaging demonstrated a new left upper lobe PET-avid nodule, resulting in completion left upper lobectomy revealing LCNEC, with 0/6 involved lymph nodes and negative staging studies. The patient subsequently chose surveillance over adjuvant chemotherapy; unfortunately 23 months later imaging revealed an enlarging 0.7cm nodule adjacent to the previous resection site, despite the patient remaining in good health (KPS=90). Subsequent restaging demonstrated no evidence of metastatic disease. Due to the morbidity of a third operation in this region, and based on the safety of SBRT for Stage I non small-cell lung cancer, the consensus decision from our thoracic oncology team was to proceed with SBRT as preferred management for presumptive second recurrence of LCNEC. The patient shortly thereafter underwent SBRT (50Gy in 10Gy/fraction) to this new nodule, 41 months following initial LCNEC diagnosis.

Results

Four months following SBRT, the patient remains in excellent clinical condition (KPS 90), with no evidence of disease spread on surveillance studies. The nodule itself demonstrated no evidence of growth following SBRT.

Conclusions

This first report of SBRT for pulmonary LCNEC demonstrates that SBRT is a feasible modality for this rare disease. A multidisciplinary thoracic oncology approach involving medical oncology, thoracic surgery, radiation oncology and pulmonology is strongly recommended to ensure proper patient selection for receipt of SBRT.

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Keywords

Pulmonary large cell neuroendocrine carcinoma; SBRT; Radiation oncology; Medical oncology; Thoracic surgery

About this article
Title

First report of pulmonary large cell neuroendocrine carcinoma treated with stereotactic body radiation therapy

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 6 (2019)

Pages

507-510

Published online

2019-11-01

DOI

10.1016/j.rpor.2019.08.005

Bibliographic record

Rep Pract Oncol Radiother 2019;24(6):507-510.

Keywords

Pulmonary large cell neuroendocrine carcinoma
SBRT
Radiation oncology
Medical oncology
Thoracic surgery

Authors

Shearwood McClelland
Gregory A. Durm
Thomas J. Birdas
Paul M. Musto
Tim Lautenschlaeger

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