American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is recommended for small cell lung cancer patients with a complete response after chemotherapy?

1. Surgical resection

2. Prophylactic cranial irradiation

3. Observation only

4. Targeted therapy

The correct answer is: Prophylactic cranial irradiation

Prophylactic cranial irradiation (PCI) is recommended for patients with small cell lung cancer who have achieved a complete response after chemotherapy due to the characteristic behavior of this cancer type. Small cell lung cancer is known for its high tendency to metastasize to the brain, and studies have shown that administering PCI in patients with complete or near-complete responses can significantly reduce the risk of brain metastases and improve overall survival. Research indicates that PCI helps prevent the development of asymptomatic brain metastases, which can lead to neurological deficits and decreased quality of life. Therefore, incorporating PCI as a post-chemotherapy strategy aims to capitalize on the complete response and further降低 the risk of recurrence in the central nervous system. While surgical resection might be considered in other contexts, it is not typically utilized in small cell lung cancer due to the often diffuse nature of the disease at diagnosis. Observation only does not adequately address the risk of metastatic disease recurrence, and targeted therapy is not the standard of care for small cell lung cancer after chemotherapy, as this type of lung cancer does not respond to the same targeted therapies effective in non-small cell lung cancer. Thus, prophylactic cranial irradiation stands out as the appropriate option in this scenario.