My dad (59) has extensive SCLC with brain, bone, and liver mets.

[Autumn]

My dad (59) was diagnosed with extensive SCLC with brain, bone, and liver mets yesterday after being admitted to the hospital on Sunday. His oncologist has recommended treatment and said if he responds well to treatment, he could live 6 to 9 more months. I'm not sure of the specific treatment plan yet but I do know the immediate next step is whole brain radiation. I know this diagnosis is terminal and has unfortunately been caught very late for my dad, but I am looking to see if anyone has any suggestions or advice for this. I know extremely little about lung cancer, but his diagnosis seems worst-case scenario. I am having difficulty seeing how he could live 6 to 9 more months with treatment given how badly it seems to have spread. I’ve included the results from the various imaging done throughout this week. These images were taken before the biopsy results came back and confirmed SCLC.

 

CT a/p 2/20/22:

• Hepatomegaly with innumerable masses concerning for metastatic disease
• Small amount of ascites
• Sclerotic foci in the bones concerning for metastatic disease

CT Chest 2/20/22:

• Pretracheal node measures 1.8 x 1.8 cm
• Subcarinal node measures 1.4 x 2.7 cm
• Left mediastinal heterogeneous node versus mass measures 4.7 x 2.1 cm
• There is left upper lobe consolidative mass extending into the right hilum narrowing and occluding upper lobe segmental bronchi. Mass measures approximately 8.5 x 8.2 x 5.2 cm AP, transverse and craniocaudal dimensions
• Multiple left lower lobe pleural-based nodules measure up to 6 mm
• Right upper lobe pleural-based nodule measures 2 mm
• 2 degenerative changes are in the spine. Scattered sclerotic foci in the spine concerning for metastatic disease.

Abdominal US 2/20/22:

• Innumerable hepatic masses most consistent with metastasis 

Bone Scan 2/21/22:

• Multiple foci of abnormal increased radiotracer accumulation in the calvarium in the left parietal bone, right anterior ninth rib and thoracic and lumbar spine.

MRI Brain 2/22/22:

• Multiple ring enhancing lesions surrounding vasogenic edema as follows:
  • A 1.8 x 1.2 cm lesion is noted within the right posterior cerebellum
  • A 0.5 x 2.9 cm lesion is located in the inferomedial right cerebellar hemisphere
  • A 0.5 x 0.4 cm lesion is noted in the left occipital lobe
  • A 1.0 x 1.0 cm lesion is noted in the anterior right frontal lobe
  • A 0.3 x 0.4 cm lesion is noted in the left parietal bone.
• There are scattered nonspecific t2 hyperintensities noted in the periventricular and subcortical white matter.

[Tom Galli]

Autum,

Welcome here, unfortunately.

SCLC comes in but two stages: limited and extensive. Your dad's diagnosis appears to be extensive indeed. First, I suggest you read some easily understandable information on SCLC here. This cites radiation and chemotherapy as treatment possibilities. In addition to whole brain radiation you mentioned, fractional radiation might be used to attack the large masses in the chest. I'd ask your dad's medical oncologist for a consultation with a radiation oncologist to explore that treatment option.

Note also that immunotherapy has emerged as a treatment method. If applicable, this might be included as combination systemic therapy administered concurrently with conventional chemotherapy (carboplatin and etoposide). 

You are right. Your dad's cancer was caught very late. Conventional chemotherapy can be very effective in knocking down tumors but SCLC is so very dangerous because it frequently recurs after conventional chemo. Then, there is little to throw at the beast.

Here is what I'd do if it were my father with this diagnosis. The prognosis for a no evidence of disease response (NED) from first-line treatment is not good. I'd try and learn what my father's desires are for the life he has remaining. Points I'd explore include: enduring difficult treatment and side effects with little probability of success; a chance of retaining brain function by having whole brain radiation knowing radiation can itself cause neurologic disorders; and declining curative treatment except for best supportive care (hospice).

This will be a difficult but necessary conversation. Your father will need to make hard choices, and you can best support his choices by providing insight and information. We'll help you with insight and information as will your dad's medicinal team. In fact, you might want to explore the aforementioned questions with your dad's medical oncologist. You should attend this consultation if possible to ensure questions get asked and answers are understood.

I wish I had better alternatives to suggest but extensive stage SCLC is indeed tough to treat.

Stay the course.

Tom

 

[Autumn]

Hi Tom. Thanks so much for your detailed response. It is really appreciated. My dad is currently in the process of getting a port put in. We are seeing a Radiation Oncologist on Monday so I plan to ask plenty of questions, then. I am still unsure of the exact treatment plan, but I do know they are going to try immunotherapy, as well.

This Radiation Oncologist, as well as the two other Oncologists my mom has spoken with over the past few days all express they think my dad is a really good candidate for treatment. They have made it clear this is incurable, but they think he will respond well. I go between feeling hopeful because of what the doctors are saying, but then feeling hopeless because of how much my dad's condition has worsened. His vitals are stable and he is most likely being discharged tonight, but he is just so weak and tired, and often confused. We celebrated my mom's birthday on Saturday and he was perfectly normal! It's so hard to wrap my head around the fact he's been having cancer spread all throughout his body with not a single major symptom until now.

[wecomu]

I am sorry that your dad suffers advanced lung cancer. I would suggest that your dad takes chemotherapy first. If there is response to chemotherapy, it could stop lung cancer cells proliferating and spreading. This will give your dad chance to try immunotherapy at the time of chemotherapy. Has your dad checked PD-1 or PD-L1 ? If the two are positive and show sustained levels, it is good for your dad to take PD-1 or PD-L1 blockage treatment. The combination of immunoltherapy and chemotherapy would keep your dad survive longer and longer.