Mom with ex SCLC not candidate for radiation - 1258066

I'm very sorry to know your mom has been diagnosed with ex sclc. When someone has extensive stage it isn't considered curable but it is treatable to extend life and raise or maintain quality of life. Chemo treats the whole body (systemic) and is used for those with extensive sclc or stage IV nsclc. Radiation only treats the target areas and isn't helpful in extending life or enhancing quality of life; unless it's used to shrink tumor that is causing pain or pushing on an organ. Here are a link that discusses this.
http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…

http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/
http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-can…

I hope this helps answers some of your questions,
Janine
forum moderator

I'm sorry to learn of your mother's diagnosis.

Janine provided a great summary of why chemotherapy alone is the main approach for extensive stage SCLC. I hope she responds well. Please let us know if you have particular questions after reviewing some of the info in the links Janine provided, which should be quite helpful.

Good luck!

-Dr. West

The nodes crossing over to the other side of the chest maybe the reason for the staging but we do need further input in can't readily find on from previous posts. I will ask a doctor to elaborate.

All best to you, your mother, and family,
Janine

Technically, SCLC should be staged by the same TNM system that NSCLC is staged by. In practice, we usually stage it with the simpler (and more functional) system of limited vs. extensive stage. In practice, we usually define limited stage as when all the cancer can be encompassed within a single radiation portal and extensive stage as when it can't. This judgement can sometimes be subjective. But, even if a patient is very fit (good performance status, good lung function) and you CAN do radiation it doesn't mean that you SHOULD do radiation. Cancer being large and having spread to many nodules and lymph nodes means that there is a very high probability of microscopic spread elsewhere, that's too small to see. While chemo gets almost everywhere in the body and can try to suppress even what you can't see, radiation only works where you shine the beam.

This doesn't mean that radiation can never help in extensive stage disease. When chemo works, after 4-6 cycles preventative radiation to the brain improves survival. There is controversy over whether some radiation to the chest might help after chemo is completed, in patients who respond; the radiation therapy oncology cooperative group is currently studying this question. When SCLC spreads in such a way that it causes problems in one spot (painful bony met or lung nodule pressing on an airway, for example) radiation can certainly help in those spots.

I know how important it is to have a good enough understanding to feel comfortable that one is getting the right treatment. It's quite difficult to explain the relief that Grace can provide, I'm just honored to be a part of it and help out.

All best,
Janine

I'm sorry your mom didn't get the results she wanted. I will ask a doctor to reply to your questions. I hope she remains stable for a long time.

All best,
Janine

Hi,

In cancer, we do view stable disease as a good thing. Of course, we would like to see the cancer shrink. However, many times we do not see this and as long as things are not progressing, I would continue the therapy. In SCLC, I have seen that sometimes additional cycles are needed. Since there are few treatment options in this disease, I would not switch to another line of therapy.

It is reassuring to know that she is tolerating the chemotherapy well.

Best,
Cathy

Thank you for your sweet statement. I'm so thankful for Grace without whom I'd be a much bigger mess.

I've pasted some quotes from a blog post written by one of our faculty who has a specialty in sclc. Dr. Gadgeel describes limited stage first then extensive stage starts somewhere in the middle of the article. It was written 3 years ago and still is the standard of care today. http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-can…

" Assuming that the cancer is shrinking or stable and the patient is tolerating the treatment without significant side-effects, the treatment is extended for 4 or perhaps up to 6 cycles. There are no data to suggest that extending treatment with this chemotherapy beyond this point has any benefit."

"After this fixed duration of treatment, patients are monitored with physical examination and scans to assess if the cancer is remaining stable. This assessment is usually done every 6-8 weeks. Unfortunately, it is expected in ED-SCLC that the cancer will show evidence of growth again, at which point the next chemotherapy treatment is started or consideration of a focus exclusively on symptom management."

Some of the titles that follow the heading "Treatment of Extensive Stage Small Cell Lung Cancer Patients" are,
Second Line Treatment
Retreatment with Cisplatin (or Carboplatin) and Etoposide
Subsequent Chemotherapy

This article will go a long way in helping you understand what your mom's options are. Such as doing 4 cycles of the platinum doublet then break then scan and possibly start a 2 line of treatment, which is what her doctor is suggesting.

I'm going to continue in another post...

Another decision point is when to treat and when focus on comfort care alone (not to be confused with giving up). Treatment decisions are made with an equal dose of quality of life and longevity. Every person is different so treatment decisions are made with those most closely involved with her treatment and everyday living. If you're not sure you're getting the appropriate treatment it's always appropriate to get a second opinion from a specialist. This blog from Dr. Weiss is very helpful when considering a second opinion. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

While Grace isn't in a position to make those decisions through a forum setting we are here to help you understand how to care best for those with cancer, so read through the info I've posted, consider how it fits your mom's situation and don't hesitate to ask any questions you have.

All best,
Janine
forum moderator

Janine,

Thanks so much for providing such a great summary of some big questions. I really agree with the strategies highlighted by Dr. Gadgeel, specifically that more is often not better.

Good luck.

-Dr. West