Long Survival of a Small-Cell Lung Cancer Patient Who Received Maintenance Chemotherapy with Irinotecan
A 58-year-old Japanese man was referred to our hospital due to a dry cough continuing for over 3 weeks. He was a former smoker with a 45 pack-year history. Chest X-ray showed left pleural effusion and consolidation in the left hilum. Computed tomography (CT) of the chest revealed left pleural effusion and a large tumor of about 120 mm invading the aorta and main pulmonary artery directly (fig. ). He was diagnosed with SCLC based on pleural effusion cytology. The serum concentration of neuron-specific enolase had increased to 24.8 ng/ml, and pro-gastrin-releasing peptide had also increased to 987.5 pg/ml. Abdominal CT, whole-body bone scintigraphy and brain magnetic resonance imaging did not reveal any distant metastasis. Therefore, the clinical stage of his disease was determined as T4N2M1a, stage IV. Four cycles of chemotherapy, consisting of cisplatin and irinotecan, were performed and a partial response was achieved (fig. ). Neuron-specific enolase and pro-gastrin-releasing peptide levels decreased to the normal range. Toxicity was quite mild and the patient had a strong wish to continue chemotherapy. Therefore, we started maintenance chemotherapy with irinotecan after the initial treatment. The patient underwent 24 cycles of maintenance treatment with irinotecan without marked toxicity. Subsequently, 2 years and 6 months after the initial diagnosis, 18F-fluorodeoxyglucose positron emission tomography showed no positive sign of disease; the main tumor, lymph nodes, and pleural effusion had completely disappeared and the response was defined as a complete response (fig. ). Based on these results, we decided to withdraw chemotherapy. Currently (3 years since the initial diagnosis), disease relapse has not been documented and the patient is still alive without any complaints.