Medicine · 2025
Multidisciplinary management of concurrent small cell lung cancer and hepatocellular carcinoma: A rare case report with long-term survival.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Li Ying, Zhang Xu, Wang Yi-Qian, Lv Hai-Chen, Zhao Shi-Lei, Li Zhi-Yong, Wang Jun-Ying, Zhao Yi
Аннотация
RATIONALE: Coexisting small cell lung cancer (SCLC) and hepatocellular carcinoma (HCC) is extraordinarily uncommon; in elderly patients with cardiac dysfunction it demands highly individualized, cardio-conscious care.
PATIENT CONCERNS: A 72-year-old man experienced an acute myocardial infarction in September 2019 and underwent emergency percutaneous coronary intervention. He had well-controlled hypertension and diabetes but no viral hepatitis history.
DIAGNOSES: Follow-up contrast computed tomography (December 2019) showed a 1.4 cm left-upper-lobe nodule and an 8 cm hepatic mass. Video-assisted biopsy confirmed stage IIIA SCLC (pT1N2M0). Right-hepatectomy pathology established primary HCC. Baseline echocardiography revealed New York Heart Association class III heart failure with left-ventricular ejection fraction of 40%.
INTERVENTIONS: The multidisciplinary team performed thoracoscopic lobectomy with mediastinal dissection (January 2020) followed by right hepatectomy (November 2020). Adjuvant therapy was withheld because of severe cardiac compromise. On SCLC progression, the patient received 4 cycles of carboplatin-etoposide, thoracic conformal radiotherapy, and atezolizumab maintenance. Concurrent cardio-oncology management - guideline-directed heart failure medication, serial echocardiography, and endocrinologic treatment of immune-related subclinical hypothyroidism - mitigated therapy-related toxicity.
OUTCOMES: The patient achieved a durable partial response lasting >18 months. Left ventricular ejection fraction remained ≥40% after temporary decline, and immune adverse effects were controlled. Overall survival reached 39 months; he ultimately died of COVID-19 pneumonia in January 2023.
LESSONS: Meticulous multidisciplinary team coordination can balance oncologic efficacy and cardioprotection, enabling meaningful survival for patients with simultaneous SCLC and HCC complicated by severe cardiac dysfunction.
PATIENT CONCERNS: A 72-year-old man experienced an acute myocardial infarction in September 2019 and underwent emergency percutaneous coronary intervention. He had well-controlled hypertension and diabetes but no viral hepatitis history.
DIAGNOSES: Follow-up contrast computed tomography (December 2019) showed a 1.4 cm left-upper-lobe nodule and an 8 cm hepatic mass. Video-assisted biopsy confirmed stage IIIA SCLC (pT1N2M0). Right-hepatectomy pathology established primary HCC. Baseline echocardiography revealed New York Heart Association class III heart failure with left-ventricular ejection fraction of 40%.
INTERVENTIONS: The multidisciplinary team performed thoracoscopic lobectomy with mediastinal dissection (January 2020) followed by right hepatectomy (November 2020). Adjuvant therapy was withheld because of severe cardiac compromise. On SCLC progression, the patient received 4 cycles of carboplatin-etoposide, thoracic conformal radiotherapy, and atezolizumab maintenance. Concurrent cardio-oncology management - guideline-directed heart failure medication, serial echocardiography, and endocrinologic treatment of immune-related subclinical hypothyroidism - mitigated therapy-related toxicity.
OUTCOMES: The patient achieved a durable partial response lasting >18 months. Left ventricular ejection fraction remained ≥40% after temporary decline, and immune adverse effects were controlled. Overall survival reached 39 months; he ultimately died of COVID-19 pneumonia in January 2023.
LESSONS: Meticulous multidisciplinary team coordination can balance oncologic efficacy and cardioprotection, enabling meaningful survival for patients with simultaneous SCLC and HCC complicated by severe cardiac dysfunction.