What concurrent dose/fractionation regimen do you prefer when treating large cell neuroendocrine tumor of the lung?

This is an interesting problem. Assuming the pathologist reports this as "large cell neuroendocrine", essentially this is a non-small cell lung carcinoma and we treat as such recognising the significant concern for brain metastasis. We do not do PCI for these patients and a pre-treatment MRI brain is mandatory as part of staging like any lung cancer. As such, the standard thoracic treatment of the chest is 60 Gy concurrent with cis/etoposide assuming the patient can tolerate the treatment. A non...

I would get the pathology reviewed at a large center to make sure this is not a pulmonary neuroendocrine tumor (typical or atypical) carcinoid. The management would be different, as would imaging, the role of XRT, and selection of technique/volume/dose, etc.