How would you approach a patient with simultaneously diagnosed stage IVA SCC of the head and neck and limited stage small cell lung cancer (neither is symptomatic)?

Would you recommend chemo alone first? Would you treat with definite chemo-RT to the lung then the head/neck or vice versa? How would this change if the SCLC was Extensive Stage?

1 Answer

Mednet Member

Radiation Oncology · Hackensack-Meridian

Answered on

The treatment option with ES-SCLC may be slightly more clear since the patient has incurable disease and will succumb to their lung disease. I would start chemotherapy and keep an eye on the H&N cancer and offer palliation as needed including a QUAD shot (depending on the size of the primary and symptoms). You can consider more definitive radiation depending on response to chemotherapy.

With LS-SCLC you are dealing with 2 cancers that are potentially curable though the survival is going to be driven by the SCLC. I would therefore still start with chemoRT for the lung cancer and start RT with the first cycle and get it done in 3 weeks (bid regimen or if not possible even consider 40 or 45 Gy in 15 as has been recommended elsewhere on the forum). I would start the head and neck part after completion of thoracic RT. Presumably he will still be getting chemo for his lung cancer (and possibly use 80 mg/m2 cisplatin and 100 mg/m2 etoposide regimen instead of 60 mg/m2 cisplatin and 120 mg/m2 etoposide) thus providing him the best chance of cure.