What is the downside of adding radiation to Chemo for SCLC? - 1250298

Hi Richie and welcome to Grace. I'm very sorry to hear of your diagnosis, I can only imagine. I'm not a doctor and will contact one for input but want to say that since the liver nodule is consistent with malignancy and all other arrows point to ext. stage then a biopsy isn't always taken. But I must say I see your point about biopsy ing the liver to make sure. Concurrent radiation and chemo is much more toxic than giving one or/then the other. You would want to make sure radiation would be helpful first.

Let's see what a doctor has to say. You should hear back within a day.

Janine
forum moderator

The fact that it's a hypermetabolic spot on PET that appears to be very consistent with metastatic spread in a cancer known for a high probability of early spread makes it understandable that you'd be treated for extensive stage SCLC. Concurrent chemo and radiation is one of the harder treatment strategies we pursue in patients with lung cancer, and it's justifiable if there's a realistic probability of cure that can counterbalance the acute side effects such as esophagitis that can be pretty severe, and the potential for long term damage to lung function. However, if there isn't a realistic probability for profound benefit, it's really not considered advisable to undertake the considerable short and long-term risks just for the sake of completeness in a rather hypothetical situation that what appears pretty conclusively to be metastatic spread actually isn't.

Good luck.

-Dr. West

Hi Richie: I am sorry to hear about this diagnosis. You ask a very valid question. In general, when patients present with metastases, we know that the disease is systemic. At that point, our goals are different than when patients present with local disease. When patients have local disease, we push treatment (and all of its side effects) very hard for a short period of time in the hopes for cure. On the other hand, in the setting of metastases, patients will need to be treated for longer periods of time, thus we would like to minimize the symptoms and preserve quality of life. Your doctor is right about the fact that the inital chemotherapy is the same regardless if we would add radiation therapy. Will the presence of a liver metastasis be confirmed (either MRI of the liver or biopsy)? If this is done soon and there is no mass, radiation therapy can be added to the second or third cycle of chemotherapy. If this is done and there is a liver metastasis OR if we just assume that there is a liver metastasis based on the tests done so far, and your disease responds to 4 to 6 cycles of chemotherapy with resolution of the liver mass, improvement in the size of the lymph nodes, and no other disease, then we can give consolidative radiation to the main lung mass and lymph nodes (as well as prophylactic radiation therapy). This modality of therapy has been shown to have good outcomes and is being tested in a larger trial currently. Good luck with your treatment.