Stage IV small cell lung cancer: no abnormality after chemotherapy, radiotherapy, and TCM follow-up

What happened, in summary

A 68-year-old man was diagnosed in October 2017 after cough, shortness of breath, and fatigue led to chest CT showing a left hilar mass and a left upper-lobe nodule. PET/CT showed a hypermetabolic left hilar mass, extensive lymph-node involvement in the supraclavicular, subclavian, mediastinal, paratracheal, paraaortic, subcarinal, and bilateral hilar regions, and metastatic tumors in both lungs. Left lung biopsy showed small cell carcinoma. He started first-line cisplatin plus etoposide on October 28, 2017. Alongside chemotherapy, he received traditional Chinese medicine decoctions adjusted across visits for symptoms such as sticky phlegm, shortness of breath, appetite loss, bowel changes, fatigue, and headache. Lung radiotherapy was delivered 30 times during early treatment. After 4 cycles of cisplatin and etoposide, CT showed the left hilar lesion and mediastinal lymphadenopathy had become smaller. Treatment side effects included leukopenia and gastrointestinal reactions, managed with granulocyte growth factors, Leucogen tablets, and ondansetron. In November 2018, brain MRI showed a left occipital lesion considered possible metastasis; after 30 sessions of local radiotherapy, the lesion disappeared on enhanced head MRI. In August 2019, a bone scan showed increased uptake in the right 10th rib that could represent bone metastasis, followed by local radiotherapy and 4 more cycles of cisplatin plus etoposide. By May 2020, PET/CT showed disappearance of the left hilar mass, near-disappearance of the original mediastinal and hilar nodes, and disappearance of the left intrapulmonary metastasis. After 4 years of follow-up, no abnormality was found, and his daily function and quality of life had improved.