What is your preferred approach for late recurrence at a primary site only of a limited stage small cell lung cancer initially treated with chemoradiaton?

"Late" recurrences of small cell lung cancer are unusual. For example, brain metastases very rarely develop after 3 years, and most have developed by 2 (NEJM 1999;341:476). A similar pattern has been observed for local disease (JCO 1997;15:3030). Thus, one must be suspicious when a "late" recurrence develops that it is not small cell. Indeed, we have observed this at our institution where a non-small cell carcinoma developed in the same region as a previously controlled small cell. Whether this phenomenon represents a de novo primary tumor or persistent remnants of an initial mixed histology tumor (SCLC and NSCLC components) is not always clear. Thus, a biopsy of the purported recurrence is mandatory.

If a biopsy does confirm SCLC, and stag...