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Limited-stage small-cell lung cancer after chemoradiotherapy — SCE Respiratory MCQ

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HardLung CancerLimited-stage small-cell lung cancer after chemoradiotherapySCE Respiratory

A 68-year-old woman with T3N2M0 small-cell lung cancer and WHO performance status 1 completes her planned four cycles of carboplatin–etoposide with twice-daily thoracic radiotherapy, started during cycle 2. Carboplatin was selected because her creatinine clearance was 38 mL/min. Restaging CT shows a partial response with no new lesions, and contrast-enhanced brain MRI shows no intracranial metastases. She has no clinically significant autoimmune disease or other contraindication to immune-checkpoint inhibition. Which management plan is most appropriate now?

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Correct answer: A — Offer prophylactic cranial irradiation with durvalumab consolidation

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

This patient has limited-stage SCLC that has not progressed after platinum-based chemoradiotherapy. Carboplatin remains qualifying platinum therapy: NICE permits its substitution for cisplatin in renal impairment. Her partial response, rather than complete response, does not exclude either intervention. NICE recommends prophylactic cranial irradiation at 25 Gy in 10 fractions for limited-stage SCLC with WHO performance status 0–2 when disease has not progressed after first-line treatment. A negative post-treatment brain MRI excludes established cerebral metastases but does not, in current UK guidance, replace prophylactic cranial irradiation. NICE TA1099 additionally recommends durvalumab as an option for adults whose limited-stage SCLC has not progressed following platinum-based chemoradiotherapy. She should therefore be offered both treatments. A reflects the previous post-chemoradiotherapy pathway but omits now-available durvalumab consolidation. B is attractive because MRI surveillance has been investigated as an alternative to cranial irradiation, particularly in extensive-stage disease, but it is not the recommended substitute here. D is inappropriate after completion of definitive thoracic radiotherapy without a specific indication for re-irradiation. E is incorrect because platinum–etoposide is not continued as maintenance after the planned first-line course.

Reference: Lung cancer: diagnosis and management (NG122) — Management, section 1.10 (Published 28 March 2019; recommendation 1.10.5 amended 2019; minor guideline update February 2026) — https://www.nice.org.uk/guidance/ng122/chapter/Management Durvalumab for treating limited-stage small-cell lung cancer after platinum-based chemoradiotherapy (TA1099) (1 October 2025) — https://www.nice.org.uk/guidance/TA1099/chapter/1-recommendation