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Lung Cancer |

Primary Lung Sarcoma Treated With CyberKnife Radiosurgery

Carla Wang-Kocik, MD; Ravali Tarigopula, MD; Nazly Shariati, MD; Navitha Ramesh, MD; Ahmed Abdelmagid, MD; Daniel Unachukwu, APN
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Newark Beth Israel Medical Center, Newark, NJ


Chest. 2013;144(4_MeetingAbstracts):636A. doi:10.1378/chest.1704027
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Abstract

SESSION TITLE: Cancer Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: We present an unusual case of primary lung sarcoma diagnosed promptly and managed with CyberKnife Radiosurgery as a curative treatment option.

CASE PRESENTATION: An 85-year-old male lifetime non-smoker, presented with sudden onset of shortness of breath. His past medical history was significant for Multiple Myeloma diagnosed 10 years ago. Physical examination revealed temperature of 98.1 F, respiratory rate 18/min, heart rate 72/min and blood pressure 135/84 mmHg. His lungs were clear to auscultation. Remainder of the physical examination was within normal limits. Chest radiography revealed a right upper lobe ill-defined dense opacity. A CT scan of the chest, which followed, revealed a 2 cm right upper lobe nodule. An FDG-PET/CT demonstrated a 2 cm hypermetabolic nodule with SUV of 7.0, small foci of uptake in each hilum with SUV of 2.7 on the left and 2.4 on the right. Needle biopsy of the nodule revealed cells that were diffusely positive for vimentin but negative for multiple keratin immunostains, which was most consistent with primary pulmonary sarcoma. The patient had an elective outpatient endobronchial ultrasound (EBUS) of hilar lymph nodes, which were negative for malignant cells. Considering his age, patient refused surgical intervention and opted for stereotactic radiosurgery. Following his CyberKnife Radiosurgery, he is asymptomatic pending CT scan of his chest in 3 months.

DISCUSSION: Primary lung sarcomas account for <1% of all lung malignancies. They are very aggressive and metastasize hematogenously. Surgical resection is the treatment of choice in early stages. In advanced stages use of Neoadjuvant chemotherapy has been reported in few case reports. Considering his age, our patient chose a different approach, CyberKnife Radiosurgery, which is a non- invasive alternative to surgery for the treatment of his primary lung sarcoma.

CONCLUSIONS: CyberKnife Radiosurgery is a viable non-invasive alternative to surgery for both cancerous and non-cancerous tumors in different parts of the body, including the lungs.

Reference #1: Etienne-Mastroianni B, Falchero L, Chalabreysse L, Loire R, Ranchère D, Souquet PJ, Cordier JF. Primary sarcomas of the lung: a clinicopathologic study of 12 cases. Lung Cancer. 2002 Dec; 38(3): 283-9.

Reference #2: Julius P. Janssen, MD, Jef J.S. Mulder, MD, Sjoerd S. Wagenaar, PhD, Hans R.J. Elbers, PhD, Jules M.M. van den Bosch, PhD. Primary sarcoma of the lung: A clinical study with long-term follow-up. Ann Thorac Surg 1994;58:1151-1155

DISCLOSURE: The following authors have nothing to disclose: Carla Wang-Kocik, Ravali Tarigopula, Nazly Shariati, Navitha Ramesh, Ahmed Abdelmagid, Daniel Unachukwu

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