McClelland Shearwood, Durm Gregory A, Birdas Thomas J, Musto Paul M, Lautenschlaeger Tim
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States.
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
Rep Pract Oncol Radiother. 2019 Nov-Dec;24(6):507-510. doi: 10.1016/j.rpor.2019.08.005. Epub 2019 Sep 2.
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.
A 54-year-old woman with a left upper lobe pulmonary nodule underwent a wedge resection with thoracoscopic mediastinal lymph node dissection, revealing a 2.3 cm 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 0.7 cm 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 (50 Gy in 10 Gy/fraction) to this new nodule, 41 months following initial LCNEC diagnosis.
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.
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.
肺大细胞神经内分泌癌（LCNEC）是一种非常罕见的疾病，约占肺癌的3%。即使是I期疾病，切除术后复发也很常见，五年总生存率较低。我们报告首例立体定向体部放疗（SBRT）治疗肺LCNEC的病例。
一名54岁女性，左上肺结节，接受了胸腔镜纵隔淋巴结清扫楔形切除术，病理显示为2.3 cm pT1b N0 LCNEC。大约一年后，监测影像显示左上叶出现一个新的PET阳性结节，遂行左上肺叶切除术，病理仍为LCNEC，6枚淋巴结均未受累，分期检查为阴性。患者随后选择观察而非辅助化疗；不幸的是，23个月后影像显示在先前切除部位附近有一个0.7 cm的结节增大，尽管患者健康状况良好（KPS = 90）。后续重新分期显示无转移疾病证据。鉴于该区域第三次手术的风险，且基于SBRT治疗I期非小细胞肺癌的安全性，我们胸科肿瘤团队一致决定采用SBRT作为LCNEC推定二次复发的首选治疗方法。该患者在初次诊断LCNEC 41个月后，很快接受了针对这个新结节的SBRT（50 Gy，分10次，每次10 Gy）。
SBRT后四个月，患者临床状况极佳（KPS 90），监测检查未发现疾病扩散迹象。SBRT后结节本身未显示生长迹象。
首例SBRT治疗肺LCNEC的报告表明，SBRT是治疗这种罕见疾病的一种可行方法。强烈建议采用多学科胸科肿瘤治疗方法，包括医学肿瘤学、胸外科、放射肿瘤学和肺病学，以确保正确选择接受SBRT的患者。
