Intramedullary spinal cord recurrence after high-dose chemotherapy and autologous peripheral blood progenitor cell transplantation for limited-disease small cell lung cancer

Intramedullary spinal cord metastasis is very rare in small-cell lung cance r (SCLC), and develops in only 2% of neurological disorders associated with SCLC according to previous reports. We describe here a patient with SCLC w ho developed intramedullary spinal cord recurrence after high-dose chemothe rapy (HDCT) followed by autologous blood progenitor cell transplantation (A BPCT). A 59-year-old Japanese male was referred to us for diagnosis and tre atment of an abnormal shadow on a chest radiograph. Based on transbronchial biopsy and staging procedures, he was diagnosed with limited-disease (LD)- SCLC. He received concurrent chemoradiotherapy followed by late intensifica tion with HDCT supported by ABPCT. He achieved complete response and was di scharged after receiving prophylactic cranial irradiation (PCI). However 6 months later, he noticed rapidly progressive weakness of the left lower ext remity and bowel/bladder dysfunction. Magnetic resonance imaging (MRI) of t he spinal cord disclosed an intramedullary tumor exhibiting an enhancement effect with Gd-DTPA at the 11-12th level of the thoracic vertebra. Immediat ely, radiotherapy to the spinal cord metastasis was given at a dose of 30 G y, and his neurological disorders were completely resolved. At this time of reporting, he is doing well without recurrence. This case indicates that i ntramedullary spinal cord is one of the recurrence sites implicated after H DCT and PCI in LD-SCLC. (C) 2000 Elsevier Science Ireland Ltd. All rights r eserved.