A 58-Year-Old Woman with a 60-Pack-Year Smoking History Is Evaluated

A 58-year-old woman with a 60-pack-year smoking history is evaluated because of hemoptysis and weight loss. Chest radiograph and CT scan show a right perihilar mass with mediastinal adenopathy. The results of CT scans of the abdomen, bone scan, and MRI of the head are otherwise negative. Examination of a specimen by bronchoscopic biopsy confirms small-cell lung cancer, and the findings suggest limited-stage disease. After the patient completes mediastinal radiation therapy and four cycles of cisplatin and etoposide, repeat CT scans indicate that her disease is in complete remission. What is the best recommendation concerning further therapy?

A) Prophylactic cranial irradiation
B) Four more cycles of chemotherapy, including a taxane
C) Resection of the localized disease
D) No further therapy; follow-up only