A small percentage of lung malignancies, or about, are lung large-cell neuroendocrine carcinomas (LCNEC). Recurrence following resection is frequent, even in Stage I illness, and it has a dismal five-year overall survival rate. The first report of stereotactic body radiation (SBRT) for pulmonary LCNEC is presented here. After undergoing a wedge resection and mediastinal lymph node dissection on an elderly woman with a left upper lobe pulmonary nodule, a N0 LCNEC was discovered. A fresh left upper lobe PET-avid nodule was discovered about a year later during surveillance imaging, which led to the completion of a left upper lobectomy that revealed LCNEC with associated lymph nodes and unfavorable staging results. In the end, the patient opted for observation rather than adjuvant treatment; however, months later imaging revealed an expanding nodule close to the previous resection site, despite the patient still being alive.
