title: [Successful treatment of small cell lung cancer with secondary immune thrombocytopenic purpura].
abstract: Chest CT on admission of a 58-year-old woman with bloody sputum showed a mass shadow at the hilum of the right lung suggesting invasion to the mediastinum, and contralateral mediastinal lymph node (#6) metastasis. Bronchial brush cytology yielded a diagnosis of small cell lung cancer (SCLC). The clinical stage was T4N3M0, stage IIIB, limited disease (LD). On admission, her platelet count was only 40 x 10(3)/microl. Blood biochemistry and bone marrow puncture revealed immune thrombocytopenic purpura (ITP). We speculated that she had secondary ITP (ITP-like syndrome) associated with cancer. Only 11 cases of lung cancer with secondary ITP have ever been reported, 4 cases of which attained complete response of cancer and complete remission of ITP by anti-cancer therapy. Therapeutic procedures employed were surgery in 3 cases of adenocarcinoma and a high dose chemotherapy (HDC) with autologous peripheral blood stem cell transplantation (APBSCT) in 1 case of SCLC. In the present case, concurrent chemoradiotherapy (four cycles of cisplatin/etoposide (PE) combined with 45Gy of thoracic radiotherapy) was performed, which resulted in a complete response of SCLC and a complete remission of the secondary ITP. This is apparently the first report of successful treatment of SCLC with secondary ITP by standard chemoradiotherapy. In a SCLC patient with ITP-like symptoms, treatment for SCLC may simultaneously resolve the ITP-like symptoms.
authors.affiliation: Department of Respiratory Medicine, Hyogo Prefectural Amagasaki Hospital.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Terashita
authors.forename: Katsuya
authors.initials: K
authors.lastname: Hirano
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hirai
authors.forename: Tomoko
authors.initials: T
authors.lastname: Narabayashi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hara
authors.forename: Kazuo
authors.initials: K
authors.lastname: Endo
authors.forename: Masataka
authors.initials: M
authors.lastname: Hirabayashi
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D011696:Purpura, Thrombocytopenic / Q000209:etiology* / Q000276:immunology; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D002945:Cisplatin