Journal of Radiotherapy in Practice
Journal of Radiotherapy in Practice (2014) Page 1 of 4 © Cambridge University Press 2014 doi:10.1017/S1460396914000302
Case Study
Small cell lung cancer metastatic to the submandibular gland Talha Shaikh 1, Hormoz Ehya2, Aruna Turaka1 Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA, 2Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
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(Received 24 April 2014; revised 8 July 2014; accepted 11 July 2014)
Abstract A 58-year Caucasian woman with a 45-pack year smoking history underwent a computed tomography (CT) scan of the chest due to a persistent respiratory infection. Imaging revealed extensive mediastinal and hilar lymphadenopathy on the right. Fine needle aspiration of the right paratracheal and subcarinal lymph nodes revealed small cell lung carcinoma. She was treated with definitive concurrent chemoradiation (with Cisplatin and Etoposide) therapy to the primary tumor and the mediastinum using intensity modulated radiation therapy. Post-treatment repeat CT of the chest showed complete radiographic response and she was offered prophylactic cranial irradiation which the patient refused. Within six months of completing treatment, the patient developed brain metastases and was treated with a course of palliative radiation to the whole brain. One month after completion, she noticed painful swelling of the left submandibular gland and a CT showed an enlarged submandibular gland. FNA revealed metastatic SCLC. She was treated with urgent palliative RT to the left submandibular gland with significant improvement in her symptoms.
Key words: small cell lung cancer; submandibular gland; palliative; whole brain radiation therapy
INTRODUCTION Despite significant advancements in the management of small cell lung cancer (SCLC) the median overall survival remains poor. One of the main reasons for the poor prognosis is the strong likelihood of an advanced stage at the time of diagnosis. Approximately 70% of patients diagnosed with SCLC are found to have extensive disease. Median overall survival for untreated patients is only 6 weeks whereas patients who may have some form of multi-agent chemotherapy Correspondence to: Aruna Turaka, Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. Tel: 215 728 3022. Fax: 215 214 1629. E-mail: Aruna.
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followed by prophylactic cranial irradiation (PCI) are still only likely to survive 5 to 7 months. One of the factors that make SCLC particularly devastating is its propensity to metastasise. Approximately 60% of patients will have metastatic disease at the time of diagnosis. Most commonly the disease is found to metastasise to the liver, adrenals, bone and brain. Extrapulmonary neuroendocrine tumours are particularly rare and account for
