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Vol.50 No.6 contents | Japanese/English |
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- Case Report -
Significance of Local Therapy for Metastatic Foci of Locally Advanced But Well-controlled Non-small Cell Lung Cancer After Chemoradiotherapy
Takekazu Iwata1, Taiki Fujiwara1, Yukiko Matsui1, Michio Fujino1, Hisami Yamakawa11Department of Thoracic Surgery, National Hospital Organization Chiba East National Hospital, Japan
Background. Local therapy for metastatic or recurrent lung cancer lesions is usually available only as palliative therapy. In particular, the surgical resection of metastatic foci is contraindicated in cases with unresectable lung cancer unless the primary site is well-controlled. Case. A 68-year-old man with adenocarcinoma in the right pulmonary hilum (stage cT2bN1M0), was treated with chemoradiotherapy because of poor pulmonary function in October, 2000. Combined treatment resulted in partial response, therefore, low dose cisplatin, tegafur and uracil were administered as consolidative therapy. In May, 2001, however, serial CT examinations revealed a rapidly growing tumor in his spleen. Splenectomy was performed to prevent rupture of the spleen, and pathological examination showed metastasis from lung cancer. Two months later, metastasis in the right inguinal lymph node was found and resected. The right inguinal metastasis occurred again in August, 2002, but the lesion disappeared quickly after 30 Gy irradiation therapy. After the detection of metastases at the inguinal lymph nodes, gefitinib was given as an adjuvant therapy, but a new metastatic lesion was found in the paratracheal region of the mediastinum in August, 2003. The metastatic tumor was surgically removed because of no apparent invasion to the neighboring organs including the great vessels or the trachea. The patient is alive and disease-free as of September, 2009. Conclusion. In a case of locally advanced non-small cell lung cancer which was well-controlled by chemoradiotherapy, local therapeutic strategies, including irradiation and surgical resection for multiple but metachronous metastatic foci, resulted in a significant prolongation of survival. Local treatment may be selected for curative purposes when the primary site is well-controlled. Surgical resection need not be avoided if the lesion is resectable and the patient can tolerate the surgical intervention.
key words: Lung cancer, Metastasis, Surgery, Recurrence, Long-term survival
Received: January 7, 2010
Accepted: July 7, 2010
JJLC 50 (6): 809-815, 2010
