Limited-stage small cell lung cancer with no recurrence after 14 years

What happened, in summary

This 65-year-old woman had a 40 pack-year smoking history and a separate hematologic condition, JAK2 V617F-positive essential thrombocythemia, before lung cancer was found. She initially presented with transient ischemic symptoms, very high platelet counts, elevated hematocrit, and leukocytosis. Essential thrombocythemia was treated first with aspirin, then hydroxyurea, which was stopped because of hepatotoxicity, and later pegylated interferon-alpha. In September 2010, she developed persistent cough, hemoptysis, and left-sided chest pain. CT showed a 10.6 cm left upper-lobe mass with mediastinal lymphadenopathy. Fine-needle aspiration showed malignant small round cells with nuclear molding, and immunohistochemistry was CD56-positive and TTF-1-positive, supporting limited-stage small cell lung cancer. She received 4 cycles of concurrent carboplatin and etoposide with thoracic radiotherapy. Prophylactic cranial irradiation was given after treatment because small cell lung cancer has a high risk of brain relapse; no brain metastasis was described. Surveillance from 2012 to 2014 showed no recurrence, and PET imaging in 2015 and 2016 showed stable post-radiotherapy changes. She later developed other malignancies, including papillary thyroid carcinoma treated with total thyroidectomy and radioiodine, right-sided colon adenocarcinoma treated with right hemicolectomy, and basal cell carcinoma of the nose treated with radiotherapy. More than 14 years after the small cell lung cancer diagnosis, surveillance imaging confirmed no recurrence. Her platelet counts remained controlled with weekly Pegasys, while a slowly enlarging left frontal meningioma was being monitored for possible surgery. Genetic testing did not find mutations in common inherited cancer predisposition genes, including mismatch-repair and polyposis-associated genes, despite the later development of several malignancies.