Cancer is not to be feared; it can be prevented and treated. The key lies in having the correct mindset and scientific methods!
— Tsinghua University. Zhang Minghui
Small cell lung cancer (SCLC) is the most malignant type of lung cancer. In the past, the average survival time for SCLC patients was only about six months, and the five-year survival rate was essentially zero.Although technology has advanced in recent years, clinical data from the past decade indicate that despite the use of multi-drug combination chemotherapy or combined with radiotherapy, the long-term survival rate remains poor, and the local tumor control rate is also unsatisfactory.In various disease cases treated with NKT therapy, cases of SCLC are very rare. Today, we will present the preliminary treatment results of a SCLC patient who underwent treatment for half a year. Follow-up visits will continue, and we will report back to everyone.
Before analyzing this patient's case, let's first understand how malignant SCLC really is.
Popular science article: Why is SCLC so malignant?
Small cell carcinomas mainly occur in the main bronchus and lobar bronchus, with about 70% of cases presenting as perihilar masses.0%The tumor grows rapidly, with widespread metastasis occurring early, and mediastinal involvement is common, manifesting as superior vena cava syndrome, recurrent laryngeal nerve paralysis, and dysphagia.Distant metastasis to the central nervous system, bones, and liver can cause corresponding symptoms. The clinical manifestation of small cell lung cancer (SCLC) is characterized by extensive distant metastasis in its early stages. According to literature reports, when SCLC is diagnosed, 70% to 90% of patients have either clinical or subclinical lymph node metastasis or distant metastasis. The most common sites of metastasis are mediastinal lymph nodes, followed by the liver, bones, bone marrow, and brain. Some researchers believe that SCLC has already undergone distant metastasis at the outset, and therefore treat it as a systemic tumor. There is now conclusive evidence that SCLC is a poorly differentiated neuroendocrine carcinoma, rather than a small cell variant of undifferentiated carcinoma. In the new WHO classification, SCLC is not categorized alongside other neuroendocrine tumors, primarily due to the significant differences in clinical characteristics, treatment, and prognosis between SCLC and other types of neuroendocrine tumors. Chemotherapy is the foundation of treatment for SCLC, and the combination of radiotherapy and chemotherapy is currently the mainstay of treatment. The 3-year survival rate for concurrent chemoradiotherapy is between 20% and 30%.
Blood biochemical tests are commonly used for prognosis. Factors predictive of poor prognosis include: Elevated serum lactate dehydrogenase, alkaline phosphatase, alanine aminotransferase, uric acid, low serum sodium, low serum albumin, low hemoglobin, and neurospecific enolase are also used to predict prognosis.
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Mr. G, a patient, has had elevated tumor markers since April 2014, but further imaging examinations did not reveal any significant abnormalities. Regular monitoring of tumor marker changes has shown a gradual upward trend. . Until September 2018, imaging examination revealed a space-occupying lesion in the right lower lung, suggesting malignancy. In December of the same year, a thoracoscopic wedge resection of the right lower lung was performed. Postoperative pathology showed: (right lower lung) small cell neuroendocrine carcinoma, moderately-well differentiated, without invasion of the lung membrane, and no lymph node metastasis (0/5 and 0/1, respectively). Due to the absence of lymph node metastasis, early detection, and the patient's refusal to undergo chemotherapy, no additional adjuvant therapy was administered after surgery. Eight months later, tumor recurrence and metastasis were considered. CT scan revealed new masses and nodules in the surgical area, measuring approximately 3.2*2.8cm in size, with a nodule in the lumen at the opening of the posterior basal segment, and two nodules under the pleura in the left lower outer basal segment. For this recurrent lesion, the patient opted for cyber knife treatment. After precision radiotherapy, NKT cell immunotherapy was immediately administered to reduce the probability of recurrence and metastasis. Considering the malignancy of small cell lung cancer and the patient's non-participation in traditional chemotherapy, the NKT treatment regimen was intensified, with two courses per month. After receiving NKT treatment, another eight months passed. What were the results?
After 10 consecutive courses of systematic treatment, imaging examination did not reveal signs of recurrence or metastasis. The patient's quality of life improved, and physical strength increased compared to before. However, tumor markers did not show a downward trend, and continued observation and follow-up are still necessary.
Lung CT: multiple interstitial fibrosis changes in both lungs, with a 3.3*2.8cm mass shadow visible in the right lower lung on August 21, 2019, combined with 2019-The 8-26 PET-CT imaging suggests metastatic lesions.
, a follow-up examination on December 18, 2019, showed a significant reduction in the mass compared to the examination on August 21, 2019, with a small amount of pleural effusion visible in the right lower lung. Considering the history of cyberknife treatment, it is considered a post-treatment change.
On April 7, 2020, a follow-up examination showed a further significant reduction in the mass compared to the examination on December 18, 2019, with slight absorption of the pleural effusion. Close observation is recommended. Summary of the patient's condition
This patient with small cell lung cancer underwent NKT treatment for less than a year, but initial signs of improvement can be seen.
The patient developed new recurrent metastatic lesions eight months after surgery without adjuvant chemotherapy, indicating the high malignancy of small cell lung cancer. However, with the same eight-month period, after precise radiotherapy for metastatic lesions, NKT cell immunotherapy was immediately followed, and no new metastatic lesions were found on imaging currently. This indicates that the tumor growth momentum has been initially suppressed or slowed down.
Of course, the patient's current tumor markers did not show a downward trend. However, considering that it took four years from the discovery of elevated tumor markers to the diagnosis of small cell lung cancer, we will continue to follow up and track the patient's condition in the hope that he can smoothly pass the 18th and 28th months.
Article reference:
[1] Modern Oncology Zhaoqiu Tang
