Mr. Le was diagnosed with metastatic small cell lung cancer two years ago and had undergone multimodal treatment, including chemotherapy and immunotherapy. Recently, he experienced severe pain, responded poorly to painkillers, and had difficulty walking, prompting him to seek examination at Tam Anh General Hospital Hanoi.

A CT scan revealed a large 4.5 cm tumor in his right lung hilum, with extensive metastases in both lung lobes, mediastinal lymph nodes, supraclavicular fossa, and spinal bones. Doctor Vuong Ngoc Duong, Deputy Head of the Radiation Therapy Department, explained that two significant metastatic lesions in the thoracic and lumbar vertebrae were the primary cause of Mr. Le's pain and limb weakness. The doctor prescribed radiation therapy to this specific area to alleviate his symptoms.

Doctor Duong encourages Mr. Le before a radiation therapy session. *Photo: Tam Anh General Hospital*

Doctor Duong explained that bone metastases damage bone structures, compressing nerve roots or the spinal cord, leading to severe pain and motor dysfunction. While conventional or opioid-based painkillers can manage pain, their effectiveness varies among patients. Even when effective, pain relief often diminishes over time, necessitating increased dosages, especially as bone metastases continue to grow, intensifying both the severity and frequency of pain.

Palliative radiation therapy uses ionizing radiation to destroy DNA and eliminate cancer cells. While not curative, it aims to shrink tumors to alleviate symptoms such as pain, bleeding, and compression. This method directly targets metastatic tumors, effectively reducing pain.

Doctors prescribed a five-session course of palliative radiation therapy for the patient. By the second session, Mr. Le's back pain had decreased, limb weakness resolved, and his mobility was restored. Following the full course, he could walk and perform daily activities independently, significantly improving his quality of life. On a 0-10 pain scale, his pain level dropped from 8-9 to 2-3, indicating the absence of severe pain.

Mr. Le regained mobility and could walk after a five-session course of palliative radiation therapy. *Photo: Tam Anh General Hospital*

Small cell lung cancer (SCLC) originates from small-nuclei neuroendocrine cells in the lungs, accounting for approximately 15% of all lung cancer cases. It is considered the most aggressive type, characterized by rapid progression. SCLC presents in two stages: localized and extensive. According to Doctor Duong, most patients are diagnosed at the extensive stage, where cancer cells have metastasized to both lungs, lymph nodes, and distant sites such as bones and the brain. Even when the primary tumor in the lung is small, these widespread metastases often limit surgical options.

Currently, multimodal treatment protocols combining chemotherapy, immunotherapy, and radiation therapy help patients with small cell lung cancer extend their lifespan and improve their quality of life.

Thanh Long