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Answer 5
  1. Combination chemotherapy with a platinum-based regimen and concurrent thoracic radiotherapy. Lung cancer is the major cause of cancer-related death in men and women in the United States. Although this woman was not an active smoker, she had significant tobacco exposure from her husband. Passive smoking is associated with an increased rate of lung cancer, with a statistically significant increase in the squamous and small cell histologic subtypes.15 SCLC can present with central hilar lesions contributing to the most common symptoms of cough, shortness of breath, and hemoptysis.14 The central location of the mass makes bronchoscopy a good option to further elucidate the histology of the lesion. The description of the lymphocyte-like small round cells found on this patient’s bronchial washings is consistent with SCLC or oat cell carcinoma.14 SCLC can be practically classified as either limited or extensive disease; limited disease is characterized by a tumor that can be encompassed within a single, tolerable radiation port.14 Combination chemotherapy with a platinum-based regimen and concurrent thoracic radiotherapy is the mainstay treatment for local SCLC tumor growth.14 Combination chemotherapy is superior to single-agent chemotherapy, and concurrent chemoradiation offers better 5-year survival rates than sequential therapy.14 Surgical resection is not typically part of the treatment algorithm for SCLC largely due to its early spread and good response to chemotherapy. Finally, prophylactic cranial irradiation has been shown to reduce the incidence of brain metastasis in patients with limited SCLC, and guidelines for the treatment of SCLC recommend that all patients who have complete remission after chemotherapy undergo prophylactic cranial irradiation.16

    14. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med 2004;350:379–92.

    15. Pershagen G, Hrubec Z, Svensson C. Passive smoking and lung cancer is Swedish women. Am J Epidemiol 1987;125:17–24.

    16. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 2007;357:664–72.

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