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Vol.50 No.1 contents | Japanese/English |
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- Case Report -
Stage I Lung Cancer Initially Treated by Stereotactic Body Radiotherapy, Followed by Salvage Surgery for Local Recurrence
Itaru Nagahiro11Department of Surgery, Himeji Red Cross Hospital, Japan
Background. Stereotactic body radiotherapy (SBRT) is a therapeutic option for stage I lung cancer, but local recurrence after SBRT can occur. This report presents a resected case of local recurrence after SBRT. Case. A 62-year-old woman with left back pain was found to have a huge mass in the left retroperitoneal space adjacent to the adrenal gland and was referred to our hospital. The mass was diagnosed as diffuse large B-cell lymphoma by needle biopsy. Chest CT revealed a tumor (2.5 cm in diameter) in the right lower lung field, which was diagnosed as pulmonary adenocarcinoma by transbronchial biopsy. Because the left retroperitoneal lymphoma was very large (8 cm in diameter) and she had severe systemic symptoms of lymphoma (high fever, fatigue and appetite loss), chemotherapy for lymphoma [8 courses of rituximab plus CHOP (R-CHOP)] preceded lung cancer therapy. During lymphoma therapy, another systemic review was performed and the lung cancer was same size and then diagnosed as T1N0M0 stage IA. Because of her residual lymphoma and continuance of chemotherapy, general weakness (ECOG performance status 2) and pancytopenia due to the chemotherapy, surgical resection was avoided and SBRT (48 Gy) was performed for the lung cancer after R-CHOP was completed. Thereafter, 3 courses of CHOP were administered, and complete response (CR) was obtained, and also there was no recurrence of lung cancer. About 3 years later, multiple small nodules were detected around fibrosis in the right lower lobe on chest CT; needle biopsy revealed local recurrences of lung cancer. A right lower lobectomy was performed (pT4N0M0 stage IIIB), as the lymphoma remained in CR and her preoperative examination results were normal. Her postoperative course was uneventful and she had no recurrence for 10 months after the operation. Conclusion. Although SBRT is a powerful therapeutic option for stage I lung cancer, especially for patients who are not indicated for surgical therapy, local recurrence after SBRT can occur in some cases; therefore, thorough follow-up is necessary.
key words: Stereotactic body radiotherapy, Pulmonary adenocarcinoma, Malignant lymphoma, Local recurrence, Salvage surgery
Received: July 16, 2009
Accepted: November 11, 2009
JJLC 50 (1): 47-52, 2010
