Central nervous system relapse continues to be a therapeutic challenge in extensive disease small-cell lung cancer patients with initial symptomatic brain metastases and good response to chemoradiotherapy.

A summary is presented of four case studies of extensive disease small-cell lung cancer patients with initial symptomatic brain metastases, who were initially successfully treated with concurrent chemoradiotherapy of the neurocranium followed by consolidation chemotherapy and thoracic chemoradiotherapy, but shortly after the initial treatment developed a sequence of central nervous system relapses despite second-line therapy. Symptoms of the effect on the central nervous system dominated the course of the cancer disease, whereas the primary tumor mass remained in complete remission in all four patients until the end of the follow-up period.