Metastatic small cell lung cancer-01

In June 2022, a 65-year-old male patient underwent a routine physical examination, and a CT scan revealed a nodule beneath the pleura in the right upper lobe of the lung. In January 2023, the patient began to experience symptoms such as hoarseness, cough, and shortness of breath. By May 2023, his cough and shortness of breath had worsened. Scans showed significantly increased metabolic activity in the right upper lobe lung nodule, highly suggestive of lung cancer. Additionally, increased metabolic activity was observed in multiple lymph nodes, including the right supraclavicular region, mediastinum, trachea, para-aortic area, and inferior vena cava. The images also revealed multiple nodular thickenings in the right pleura with increased metabolic activity. Examination results indicated right pleural metastasis with pleural effusion, and the final diagnosis of metastatic small cell lung cancer was confirmed through pathological examination, imaging, and immunohistochemistry. The patient then actively received treatment.

Five months later, the tumor volume had significantly reduced, and most metastatic lesions had disappeared. The treatment regimen included initial atezolizumab immunotherapy combined with anlotinib targeted therapy. Atezolizumab was administered at a dose of 1200 mg on the first day, followed by a pause in treatment. Anlotinib was given orally at a dose of 10 mg daily for two consecutive weeks, followed by a seven-day rest period, forming a 21-day treatment cycle. After 15 sessions of radiotherapy, CT images showed a significant reduction in the lesion in the right lung, and the right mediastinum and lymph nodes had also significantly decreased. A follow-up CT scan on September 10, 2023, showed positive changes: a reduction in right pleural effusion, decreased right pleural thickening, and smaller mediastinal and right supraclavicular lymph nodes, with no enlargement of abdominal and retroperitoneal lymph nodes.

Compared to the scan on May 7, 2023, the scan on October 10, 2023, showed a marked reduction in the tumor. Specifically, shrinkage was observed in the nodule in the right upper lobe and in several lymph nodes near the trachea, blood vessels, para-aortic area, and inferior vena cava. The previously observed nodular thickening in the local peritoneum, right anterior chest wall, and the 11th-12th intercostal space had significantly decreased. Additionally, the slightly low-density nodular shadow in the right shoulder muscle had also significantly reduced. These results indicate that the systemic treatment regimen was effective, with most metastatic lesions disappearing and the remaining lesions significantly shrinking. Imaging evaluations suggest that the treatment regimen was successful, and the tumor is now in a partial remission stage.