Author of

• 15301

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  P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Treatment of Localized Disease - NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15336

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    P3.02-035 - A Case of Synchronous Quintuple Lung Cancers Treated with Salvage Surgery after Treatment with Erlotinib (ID 2696)

    09:30 - 09:30  |  Author(s): N. Ishikwa
    • Abstract

    Background:
    The detection of multiple ground　glass nodules(GGNs) is increasing with improvement in the computed tomography (CT) technique. Indelible GGNs are very often indicative of atypical adenomatous hyperplasia or relatively early stage lung adenocarcinoma, so its detection and accurate diagnosis are required for appropriate treatment.
    
    Methods:
    Figure 1A 64-year-old woman with no significant medical history was referred to our hospital after an abnormal shadow was detected on chest radiograph. CT showed two part-solid GGNs in the right upper lobe(diameter: S2,9mm;S3, 5mm), two solid nodules surrounded slightly part of GGN in the right middle lobe (S4, 27mm;S5, 38mm), and one part-solid GGN in the right lower lobe(S8, 8mm).Fluorine-18-fluorodeoxyglucose positron emission tomography showed abnormal uptake in the two nodules in the middle lobe. Biopsy of the nodule in S4 was performed using a bronchoscope, and the results indicated adenocarcinoma with an EGFR exon21 (L858R) substitution mutation. The two solid nodules in the middle lobe were diagnosed as intrapulmonary metastasis in the same lobe(cT3N0M0,stageIIB). Because the patient refused surgery, two courses of combination chemotherapy with cisplatin, pemetrexed, and bevacizumab were administered, which was discontinued because of the adverse effects. Therefore, oral administration of erlotinib was started, and she showed a partial response. Fourteen months after initiation of treatment with erlotinib, salvage surgery was performed. Salvage surgery involved right middle lobe resection with preoperative lipiodol marking for GGNs, upper lobe wedge resection, and lower lobe wedge resection.
    
    
    
    Results:
    The five nodules could be resected completely with adequate resection margin. Histopathologically, all nodules were diagnosed as adenocarcinoma of the lung, with a lepidic pattern and no vascular invasion. Since the histopathological features differed slightly between nodules, the lung cancers were not diagnosed as intrapulmonary metastases but synchronous quintuple lung cancers. The final histopathological diagnosis was pT2aN0M0, stage IB lung cancer.
    
    Conclusion:
    Our findings indicate that synchronous lung cancers as well as lung intrapulmonary metastasis need to be considered in patients presenting with multiple lung nodules with even a minor GGN component, and that complete resection after treatment with erlotinib could be the appropriate treatment in such cases. EGFR tyrosine kinase inhibitor (TKI) often leads lung cancers with EGFR mutations to good response, but most tumors acquire resistance to EGFR-TKI after less than 12 months treatment. There is a possibility that salvage operation is useful after treatment of EGFR-TKI.