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E. Blustein
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P3.11 - Poster Session/ Palliative and Supportive Care (ID 231)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.11-010 - Palliative Surgical Resection for Infection Superimposed on Malignancy (ID 3185)
09:30 - 09:30 | Author(s): E. Blustein
- Abstract
Background:
Typically, resection of non-small cell lung cancer (NSCLC) is done solely for curative intent. Rarely, a patient may benefit from aggressive palliative resection when non-oncologic conditions pose a greater threat to health and quality of life. A 59 year old man with cT3N1M1 NSCLC suffered from fevers, and relentless cough productive of copious foul sputum secondary to tumor necrosis and abscess (Fig. 1). Infectious symptoms worsened despite intravenous antibiotics. Clinical staging also suggested adrenal metastasis. Figure 1
Methods:
Cytology of pleural fluid was positive and right upper lobectomy revealed pT3N1 poorly differentiated squamous cell carcinoma. The specimen opened ex vivo was consistent with necrosis and abscess (Fig. 2). Figure 1
Results:
The patient tolerated resection very well, and was home without complication in 8 days. Infectious symptoms promptly cleared. He underwent six cycles of carboplatin and paclitaxel, without significant toxicity. CT and bone scan revealed no evidence of disease 18 months post-resection.
Conclusion:
In some NSCLC patients whose greatest threat to health and quality of life is related to complications such as lung abscess, focusing on clearing the infection rather than strictly adhering to oncologic curative intent criteria may improve quality of life, alleviate symptoms and improve survival. In this particular case, the patient had a relentless cough of putrid sputum and fevers. He was not a candidate for curative resection due to adrenal metastasis and positive pleural cytology. A palliative resection could be justified, as his symptoms were severe, potentially able to be resolved with surgery, and no other treatment options were available. Following resection, the infection cleared, and symptoms resolved. He then tolerated chemotherapy with a favorable response and over 18 month survival.
