Abstract: Objective: To analyze the treatment of a patient with recurrent and refractory small cell lung cancer(SCLC) intolerable further chemotherapy who gained significant efficacy by anlotinib combined with thoracic radiotherapy and to clarify the efficacy and safety of anlotinib combined with radiotherapy in the SCLC patients, and to provide the reference for the selection of treatment program of these patients. Methods: The clinical data of one patient with advanced recurrent and refractory SCLC who could not tolerate further chemotherapy were collected, and the related literatures were reviewed to analyze the efficacy and safety of anlotinib combined with thoracic radiotherapy. Results: The patient was a 70-year-old woman who had a long histroy of hypertention and diabetes,and presented with cough and shortness of breath.Based on the chest CT,biopsy and pleural effusion cytology,the patient was definitely diagnosed as extensive stage of SCLC(pleural metastasis) and then underwent a series of treatments. After three lines of chemotherapy regimens, the patient was unable to tolerate the continued chemotherapy due to the repeated reduce of neutrophil and platelet, and the disease progressed rapidly. Dyspnea aggravated,and the patient was unable to lie. Anlotinib combined with thoracic radiotherapy was initiated.Before radiotherapy,the PET-CT results demonstrated the hypermetabolic lesions including primary tumor located in upper lobe of left lung and bilateral hilar and mediastinal lymph nodes,bilateral pleural effusion.The patient was administrated orally with anlotinib 12 mg once per day for 3 d after thoracic radiotherapy of 6 G/3 f, the patient's wheeze was improved obviously and she could lie flat.However,she complained of dizziness with an increased blood pressure of 168/80 mmHg.Considering that it was related to anlotinib,and the patient's dyspnea was obviously relieved at present to ensure the safe implementation of radiotherapy,so anlotinib was suspended.After irradiation with 38 Gy/19 f,the patient's dyspnea disappeared completely;the primary tumor and metastatic lymph nodes shrank significantly. The CT results showed the intrathoracic lesions were shrank 40 d after radiotherapy;then the patient continued to system therapy. Conclusion: For the patients with SCLC unable to tolerate chemotherapy or progressed after multiple lines of chemotherapy, anlotinib combined with thoracic radiotherapy is promising.In the future,large-scaled clinical trials should be initiated to testify the efficacy and safety of anlotinib combined with thoracic radiotherapy.

Key words: small cell lung cancer, anlotinib, radiotherapy, chemotherapy