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Definitive concurrent chemoradiotherapy in a patient with stage IV non-small cell lung cancer due to cervical lymph node metastases

  • Shigeo Takahashi
  • Shintaro Tarumi
  • Jun Nakano
  • Atsushi Fujiwara
  • Masahide Anada
  • Toshifumi Kinoshita
  • Tetsuhiko Go
  • Hiroyasu Yokomise
  • Toru Shibata
Case report
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Abstract

In the American Society of Clinical Oncology guideline, it is mentioned that systemic therapy is a standard treatment, but there is no cure for patients with stage IV non-small cell lung cancer (NSCLC). Recent technical advances have facilitated the delivery of curative-intent radiation doses to some stage IV patients. In this report, we introduce a long-term disease-free survivor after concurrent chemoradiotherapy (CRT) and discuss considerations for this treatment. The patient was a 61-year-old woman diagnosed with stage IV adenocarcinoma of the lung classified as cT4N3M1c; the M1c classification was because of multiple synchronous pathologically proven cervical lymph node metastases (CLNM). We administered concurrent CRT to all lesions with a dose of 60 Gy in 30 fractions over 6 weeks. Concurrent chemotherapy consisted of two cycles of carboplatin and pemetrexed. Adjuvant chemotherapy was performed with five cycles of carboplatin and pemetrexed followed by three cycles of pemetrexed alone. As of 43 months after CRT, the patient was still alive without disease. In conclusion, our patient with stage IV NSCLC due to CLNM achieved long-term disease-free survival by concurrent CRT as with patients with locally advanced NSCLC. Patient subgroups should be explored to achieve long-term disease-free survival after definitive CRT in patients with stage IV NSCLC due to CLNM.

Keywords

Radical Concomitant Chemoradiation Advanced Lung carcinoma 

Notes

Funding

This report was supported by JSPS KAKENHI (Grant number 15K19798).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this report involving the human participant were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This report does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from the individual participant included in this report.

References

  1. 1.
    Hanna N, Johnson D, Temin S et al (2017) Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35:3484–3515CrossRefPubMedGoogle Scholar
  2. 2.
    de Boer P, Dahele MR, Senan S (2016) Is radical chemo-radiotherapy appropriate in patients with stage IV non-small-cell lung cancer due to cervical lymph node metastases? Ann Oncol 27:1973CrossRefPubMedGoogle Scholar
  3. 3.
    Bezjak A, Temin S, Franklin G et al (2015) Definitive and adjuvant radiotherapy in locally advanced non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline endorsement of the american society for radiation oncology evidence-based clinical practice guideline. J Clin Oncol 33:2100–2105CrossRefPubMedGoogle Scholar
  4. 4.
    Lopez GJL, Gomez D, Zhuang Y et al (2012) Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis. Int J Radiat Oncol Biol Phys 84:e61–e67CrossRefGoogle Scholar
  5. 5.
    Fleckenstein J, Petroff A, Schäfers HJ, Wehler T, Schöpe J, Rübe C (2016) Long-term outcomes in radically treated synchronous vs. metachronous oligometastatic non-small-cell lung cancer. BMC Cancer 16:348CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Baggstrom MQ, Stinchcombe TE, Fried DB, Poole C, Hensing TA, Socinski MA (2007) Third-generation chemotherapy agents in the treatment of advanced non-small cell lung cancer: a meta-analysis. J Thorac Oncol 2:845–853CrossRefPubMedGoogle Scholar
  7. 7.
    Gandhi L, Rodríguez-Abreu D, Gadgeel S et al (2018) Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer. N Engl J Med 378:2078–2092CrossRefPubMedGoogle Scholar
  8. 8.
    Antonia SJ, Villegas A, Daniel D et al (2017) Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N Engl J Med 377:1919–1929CrossRefPubMedGoogle Scholar

Copyright information

© The Japan Society of Clinical Oncology 2018

Authors and Affiliations

  • Shigeo Takahashi
    • 1
  • Shintaro Tarumi
    • 2
  • Jun Nakano
    • 2
  • Atsushi Fujiwara
    • 2
  • Masahide Anada
    • 1
  • Toshifumi Kinoshita
    • 1
  • Tetsuhiko Go
    • 2
  • Hiroyasu Yokomise
    • 2
  • Toru Shibata
    • 1
  1. 1.Department of Radiation OncologyKagawa University HospitalKagawaJapan
  2. 2.Department of General Thoracic, Breast and Endocrine Surgery, Faculty of MedicineKagawa UniversityKagawaJapan

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