Kindly advise My father was diagnosed with small cell lung carcinoma in July 2017. It was in stage 3 b. He started treatment in Delhi State Cancer Institute as he preferred close to home. Chemotherapy was advised weekly. Initially he was able to keep up with weekly schedule but later the blood counts (platelets and wbc) used to be less. So he was given injections of GC and intrabolin. And had Prednisolone once a day. Then the gap of chemo increased to two to three weeks. November pet scan report showed disease under control. But in March he wasn't able to take a single chemotherapy. pet scan done in April showed disease under progression. Currently he is under pain around the pelvic area and back. Sugar is fluctuating. Kindly have a look at the reports and advise if anything can be done to increase the life span. Radiation is planned. Can radiation be given around liver and lung area along with pelvic area? Zolotronic acids drip is planned but we don't have dental clearance. Any Chemotherapy meds are advisable?

Dr. Nikhilesh BorkarOncologist14yrs exp

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Small cell cancer is an aggressive cancer. The chance of cure is there only if the disease is localised to the lung. Usually prophylactic cranial radiotherapy with concurrent chemoradiation to lung is given if it is a localised disease, with surgery reserved for very early disease. For advanced disease chemotherapy usually cisplatin + Etoposide is given, which usually delays disease progression. If excellent response, then we could radiation to chest and prophylactic to cranium If the disease has progressed then second line chemotherapy is considered. If bone mets have developed, then palliative radiation is given to the bone to reduce the chances of fracture (I presume the pelvis in your case) also a Bisphosphonate or Denosumab might be added to make the bone more strong, which even delays the bone mets progression. But it needs your kidney function to be normal and your teeth to be healthy (can lead to osteonecrosis of jaw) hence dental prophylaxis advised before giving those. No role of radiation to liver or lung if disease is not under control. Please send the reports if more clarification is needed.  

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