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

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

I am 50 years old and otherwise healthy. Went for CT scan 10/12 after some shortness of breath which showed Bulky mediastinal & left hiliar adenopathy, as well as a nonspecific low density lesion of the liver which "may represent a hemangioma". Subsequent PET showed Lymph nodes and 1 spot on liver "light up"- all else ( including lungs) clear. Biopsy followed and on 11/1/12 I was Dx with SCLC.

Due to the liver spot, I am being treated as SCLC- EXT, even though the PET report stated the liver spot was "consistent with malignancy". Oncologist wanted to start Chemo right away, and recommended against liver biopsy " at this time" to be sure, as initial chemo treatment would be identical.

My question is "why wouldn't we add radiation to Chest / Lymph nodes now, just in case the liver turns out to be benign? What is the downside ( other than the side effects?)".

Thanks much- Appreciate the service you are providing to all of us.

Richie 1200

Reply To: What is the downside of adding radiation to Chemo for

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.

forum moderator

Dr West
Reply To: What is the downside of adding radiation to Chemo for

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

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: What is the downside of adding radiation to Chemo for

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.

Reply To: What is the downside of adding radiation to Chemo for

Thank you Doctors for your prompt responses.

I never doubted that we were doing the right treatment with the Chemo; I just figured that since I was physically feeling good and only 1 spot outside of Lymph nodes, we shouldn't leave a valuable "tool" in the "tool box".

I am a pretty aggressive guy, and want my team to be equally, if not more aggressive. Most of what I've seen in my research of this disease is that the longer term survivors happened to receive a combo of radiation and chemo, even if they are EXT-SCLC.

My next follow-up and chemo round is in 2 weeks- I will ask him then about plans re: liver, radiation and next scan.