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

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

Research output: Contribution to journalArticle

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 2.3 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. 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.

Original languageEnglish (US)
Pages (from-to)507-510
Number of pages4
JournalReports of Practical Oncology and Radiotherapy
Volume24
Issue number6
DOIs
StatePublished - Nov 1 2019

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Neuroendocrine Carcinoma
Large Cell Carcinoma
Radiosurgery
Radiotherapy
Lung
Rare Diseases
Thorax
Recurrence
Pulmonary Medicine
Radiation Oncology
Medical Oncology
Adjuvant Chemotherapy
Lymph Node Excision
Non-Small Cell Lung Carcinoma
Patient Selection
Thoracic Surgery
Lung Neoplasms
Lymph Nodes
Morbidity
Safety

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

First report of pulmonary large cell neuroendocrine carcinoma treated with stereotactic body radiation therapy. / McClelland, Shearwood; Durm, Gregory A.; Birdas, Thomas; Musto, Paul M.; Lautenschlaeger, Tim.

In: Reports of Practical Oncology and Radiotherapy, Vol. 24, No. 6, 01.11.2019, p. 507-510.

Research output: Contribution to journalArticle

McClelland, Shearwood ; Durm, Gregory A. ; Birdas, Thomas ; Musto, Paul M. ; Lautenschlaeger, Tim. / First report of pulmonary large cell neuroendocrine carcinoma treated with stereotactic body radiation therapy. In: Reports of Practical Oncology and Radiotherapy. 2019 ; Vol. 24, No. 6. pp. 507-510.
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AU - Birdas, Thomas

AU - Musto, Paul M.

AU - Lautenschlaeger, Tim

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AB - 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 2.3 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. 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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