Small-cell lung cancer: complete response complicated by radiation bronchial injury and adrenal recurrence

What happened, in summary

This 45-year-old non-smoking man was admitted in March 2023 with low-grade fever, chest tightness, and cough. PET/CT showed a hypermetabolic mass in the right lower lobe, hypermetabolic mediastinal and right hilar lymph nodes, and poor expansion of the right lower lobe. Bronchoscopy found a mass in the intermediate bronchus, and biopsy confirmed small-cell lung cancer. The case was treated as limited-stage small-cell lung cancer. From March to July 2023, he received 5 cycles of etoposide and cisplatin, with etoposide given on days 1-5 and cisplatin on days 1-3 of each 21-day cycle. During cycles 2-3, he also received moderately hypofractionated radiotherapy, planned with four-dimensional CT and delivered as 65 Gy in 25 fractions to the primary tumor and involved lymph nodes. He completed chemoradiotherapy as scheduled, with good tolerance and a satisfactory response. One month after radiotherapy, cough, phlegm, and wheezing developed and gradually worsened. CT and bronchoscopy later showed right main bronchial wall thickening, bronchial occlusion, inflammatory exudate, scarring, and granulation tissue rather than active tumor. He received anti-infection treatment and prednisone, then prophylactic brain irradiation in November 2023 with hippocampal protection at 25 Gy in 10 fractions. In July 2024, near-complete right main bronchus occlusion caused worsening chest tightness and shortness of breath; bronchoballoon dilation improved his symptoms. By November 2024, PET/CT showed no visible primary lung lesion or mediastinal metastatic lymph nodes, but a new left adrenal metastasis had developed. As of May 2025, he had restarted systemic etoposide and cisplatin for metastatic recurrence after an initial complete response.