Lung Cancer |

Is Surgical Resection for Advanced NSCLC the Answer? FREE TO VIEW

Kathryn Heal, DO; Craig Gordon, DO; Philip Kaplan, DO; Wil VanderRoest, DO
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Botsford Hospital, Farmington Hills, MI

Chest. 2014;146(4_MeetingAbstracts):616A. doi:10.1378/chest.1991758
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SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Surgical resection for stage IV NSCLC is generally not an option. However, with good response to treatment surgical resection may provide patients with extended survival.

CASE PRESENTATION: A 67 year old male was diagnosed with NSCLC and a solitary metastasis to the liver by bronchoscopy and liver biopsy. Prior to treatment, his clinical stage was IV. He was treated with combination chemotherapy and radiotherapy for four cycles at three week intervals with a combination of gemcitabine and cisplatin and concurrent radiotherapy. He then underwent repeat imaging studies. The tumor that was initially demonstrated in the lung had decreased in size by nearly 90% and the previously hypermetabolic lesion in the liver was no longer PET avid. At this point, the possibility of resection of RUL lung mass was discussed with the patient and his family and the case was subsequently presented at tumor board. The decision was made that he could benefit from an extended survival and surgery was planned. The patient underwent surgical resection of the RUL. Complete excision of the tumor was achieved with clear margins and confirmation on pathology.

DISCUSSION: Stage IV NSCLC is generally unresectable, however in this case resection was the appropriate choice to give this patient a chance at extended survival. The patient’s initial prognosis was grim and he was told that surgery though it may be possible would most likely not be an option. His response to treatment was remarkable with resolution of his liver metastasis and nodal involvement. The decision to proceed with resection is controversial because a case of this type is not common. However, in a retrospective trial it was shown that a 36% 5 year survival rate was achievable with multimodality treatment including lung resection in patients with single site metastatic NSCLC (1).

CONCLUSIONS: Patients with untreated stage IV NSCLC have a very poor prognosis with a 5 year overall survival rate of 5% or less (2). With the possibility of extended survival, surgical resection should be considered in these patients.

Reference #1: Collaud S, Stahel R, Inci I, Hillinger S, et al. Survival of patients treated surgically for synchronous single-organ metastatic NSCLC and advanced pathologic TN stage. Lung Cancer. 2012 Dec;78(3):234-8.

Reference #2: Hengst W, Hendriks J, Van Schil P. Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy. Antwerp: Belgium, 2012. Print.

DISCLOSURE: The following authors have nothing to disclose: Kathryn Heal, Craig Gordon, Philip Kaplan, Wil VanderRoest

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