Small Cell Lung Cancer Treatment and Prognosis
My father-in-law has small cell lung cancer. He was treated with chemotherapy and radiation therapy. They then discovered a metastasis in his brain. So, he was started on radiation to his brain. As far as I know, the cancer is only in the left lung and one site in the brain. Will you please tell me what is the average time he may survive? Have you ever seen anyone cured after the cancer spreads to the brain? He is sick and tired of chemotherapy and he doesn't want to receive any more. What do you suggest? Is further treatment useless in this situation?
Barbara Campling, MD, Medical Oncologist, responds:
I am sorry to hear about your father-in-law's small cell lung cancer. This is a fairly common variety of lung cancer that differs from non-small cell lung cancer because it can spread more rapidly, particularly to the brain, as it did in his case. When small cell lung cancer is confined to the chest at diagnosis, it can sometimes, although infrequently, be cured with aggressive chemotherapy and radiation therapy, which are often administered at the same time. This may have been the situation when your father-in-law's doctors started to treat him. Unfortunately, his cancer has now spread to the brain. The usual treatment for recurrence in the brain in a patient with small cell lung cancer is radiation to the whole brain. This is often very effective at reducing the size of the cancer deposit in the brain and improving symptoms, but it does not always eradicate the cancer in the brain and is a palliative, not curative, treatment. Once small cell lung cancer has spread outside of the chest, it is generally not curable with any form of therapy. The usual life span in someone with small cell lung cancer that has spread to the brain is measured in weeks or months, and only rarely years. However, it is very difficult to predict the length of survival in any individual patient, and patients with brain metastasis who are younger, have better performance statuses, and have more limited disease in the chest and elsewhere in the body tend to have the best survivals.
He is now feeling sick and tired. This is not surprising. Chemotherapy can often wear patients down. Also the cancer itself could be making him sick and tired. Although small cell lung cancer often responds dramatically to initial chemotherapy, it does not respond nearly as well to second-line chemotherapy. Whether he gets further chemotherapy depends on what is causing his symptoms, and how he feels about further treatment. He should talk to his doctors about this. Regardless of whether he decides to receive more chemotherapy, there should be other measures that his doctors can take to make him more comfortable.