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Vol.52 No.1 contents | Japanese/English |
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- Case Report -
Good Outcome of Salvage Operation for Stage IV Lung Cancer Following Gefitinib Administration and Thoracic Spine Metastasectomy
Satoru Kobayashi1, Takashi Inoue1, Makio Hayama1, Masaaki Miyoshi2, Yoshiki Ishii2, Masayuki Chida11Department of General Thoracic Surgery, 2Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Japan
Background. In the Japanese Lung Cancer guidelines, gefitinib is recommended as a first-line or later chemotherapy drug for patients with epidermal growth factor receptor (EGFR) mutation-positive advanced or recurrent non-small cell lung cancer. However, acquired drug resistance is common. Case. A 65-year-old woman complaining of back pain was admitted to our hospital. She had a metastatic bone tumor in her thoracic spine area and underwent metastasectomy. Chest computed tomography also revealed a lung tumor in the left lower lobe. A pathological examination of the excised spine tumor resulted in a diagnosis of metastatic cancer from lung adenocarcinoma (cT1N0M1, c-stage IV). Gefitinib was administered following 2 courses of carboplatin (CBDCA) +paclitaxel (PTX). The lung tumor shrank following gefitinib administration, but then grew slowly during the subsequent 6 years. Thereafter, bronchofiberscopic examination revealed adenocarcinoma with T790M-tolerant gene expression. As no distant metastasis was observed, we considered that the primary tumor, but not the metastasis, had become resistant to gefitinib, and therefore, we performed a left lower lobectomy and lymph node dissection. The patient was disease-free at 20 months after the second operation. Conclusion. We achieved a good outcome in salvage surgery for stage IV non-small cell lung cancer following long-term control by gefitinib and thoracic spine metastasectomy. Salvage surgery should be considered when acquired resistance is localized in the primary tumor site.
key words: Lung cancer, Gefitinib, Salvage surgery, Isolated bone metastasis
Received: August 2, 2011
Accepted: November 16, 2011
JJLC 52 (1): 32-38, 2012
