Prophylactic cranial irradiation (PCI) is indicated. Following evaluation for pneumonia, this patient was diagnosed with limited-stage small cell lung cancer (SCLC). The definition of limited-stage disease consists of disease limited to one hemithorax, with hilar and mediastinal lymphadenopathy that can be encompassed within one tolerable radiotherapy portal. Combined chemotherapy and radiation therapy induced a significant near-complete response in this patient. At initial diagnosis and following treatment, there was no evidence of cerebral metastatic disease. Despite these results, she remains at significant risk for recurrence of small cell lung cancer. In addition, approximately one third of patients without cerebral metastatic disease at initial diagnosis will have brain metastases at the time of disease recurrence. Randomized trials assessing the role of PCI in patients with primary treatment–responsive SCLC have identified both a reduced incidence of brain metastases and an improvement in overall survival after irradiation. PCI is currently considered standard management following response to primary treatment in these patients.

Although limited-stage SCLC tumors are one of the most chemosensitive types of tumors, there are recurrences in 90% to 95% of patients. To date, attempts to improve outcomes by providing maintenance chemotherapy, adding other agents to the standard chemotherapy regimen, or by using high-dose chemotherapy with stem cell support have been unsuccessful.

PET/CT is not a standard imaging modality to assess patients with primary treatment–responsive SCLC and would provide no new information for this patient, given her CT imaging findings.

SCLC is considered a systemic disease at diagnosis, even if a potentially resectable peripheral lesion is the only finding after diagnostic studies are completed. All patients with SCLC now receive systemic chemotherapy as the mainstay of treatment. Surgical management of SCLC is a potential option only in select cases in which there is a very small primary tumor without associated lymphadenopathy; surgical resection of a residual lung mass after chemotherapy and radiation therapy is never performed.