Salvage thoracoscopic resection after nivolumab for stage IV

2020 ◽  
Vol 28 (4) ◽  
pp. 216-218
Author(s):  
Masatsugu Hamaji ◽  
Hiroaki Ozasa ◽  
Akihiko Yoshizawa ◽  
Hiroshi Date
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Stage Iv ◽  
Small Cell ◽  
Limited Data ◽  
Small Cell Lung ◽  
Thoracoscopic Resection ◽  
Lower Lobectomy ◽  
Paratracheal Lymph Node

There are limited data on the surgical management of localized and residual diseases in patients with stage IV non-small-cell lung cancer that was treated with nivolumab. Herein, we present two patients who underwent salvage thoracoscopic resection for residual diseases (left lower lobectomy and paratracheal lymph node resection, respectively) after chemotherapy and immunotherapy for stage IV adenocarcinoma. The indications, intraoperative findings, and histopathological findings are discussed in this report.

Chemical Anaplasia in Atypical Debut of Non-small Cell Lung Cancer with Inguinal and Obturator Lymph Node Metastases

2018 ◽  
Vol 69 (10) ◽  
pp. 2833-2836
Author(s):  
Laura Rebegea ◽  
Aurel Nechita ◽  
Cristina Serban ◽  
Camelia Diaconu ◽  
Luana Andreea Macovei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Lymph Node Metastases ◽  
Palliative Chemotherapy ◽  
Small Cell ◽  
Lumbar Region ◽  
Small Cell Lung ◽  
Node Metastases

Non-small cell lung cancer (NSCLC) represents almost 80-85% of lung cancer cases. It is the most frequent malignancy after skin cancer. The therapeutic options for stage IV of disease consider histology, molecular characteristics, age, performance status, comorbidities, and not in the lust, patient�s option. This paper presents the case of a male patient, 73 years old, smoker, presented and treated in May 2016 in the Sf. Ap. Andrei Emergency Clinical Hospital Galati. The first sign of disease was inguinal and obturator right lymph node metastases whose histopathological test revealed metastases from malignant melanoma. Immunohistochemical tests (IHC) indicated undifferentiated carcinoma with lung as starting point, (Ck7 (+), TTF1 (+)). Thorax, abdominal and pelvic computed tomography (CT) imaging not evidenced space replacement processes in lung, but with mediastinal, right obturator and inguinal adenopathy. From personal pathological history we retain basocellular carcinoma in lumbar region, treated with surgery in 2009. It was initiated palliative chemotherapy and radiotherapy with remission of obturator and inguinal adenopathy, and at 9 months from diagnosis the Positron Emission Tomography (PET-CT) evidenced primary lung tumor situated in right superior lobe (RSL). At the present, patient is alive performing palliative chemotherapy. This case presented diagnostic and treatment issues, being a challenge for multidisciplinary team. We are mentioning the paucity of literature data regarding cases of primary tumors situated upper diaphragm which metastases in inguinal lymph nodes.

scholarly journals Clinical Impact of Supraclavicular Lymph Node Involvement of Stage IIIC Non-Small Cell Lung Cancer Patients

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 301
Author(s):  
Sunmin Park ◽  
Won Sup Yoon ◽  
Mi Hee Jang ◽  
Chai Hong Rim
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Local Control ◽  
Small Cell ◽  
Clinical Impact ◽  
Small Cell Lung ◽  
Stage Iiic ◽  
Supraclavicular Lymph Node ◽  
Grade 3

Background and Objective: Investigations on the clinical impact of supraclavicular lymph node (SCN) involvement in stage IIIC non-small cell lung cancer (NSCLC) remain scarce. We evaluated the oncological outcomes of definitive radiochemotherapy and the clinical significance of SCN involvement. Materials and Methods: Between November 2009 and June 2019, a total of 40 patients with N3-positivity and NSCLC were evaluated. Most patients received concomitant chemotherapy, but six patients who received radiotherapy (RT) alone were also included. Twenty-one patients (52.5%) received 3D-conformal RT (3DCRT), and the remainder received intensity-modulated RT (IMRT). Results: The median follow-up duration was 10.7 months (range: 1.7–120.6 months). Median overall survival (OS) and cause-specific survival (CSS) times were 10.8 months and 16.3 months, respectively. Among the 40 patients, 17 (42.5%) had SCN involvement. SCN involvement negatively affected progression-free survival (hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.04–4.17, p = 0.039) and local control (HR: 3.05, 95% CI: 1.09–8.50, p = 0.034). However, IMRT use was correlated with higher local control (HR: 0.28, 95% CI: 0.09–0.86, p = 0.027). Grade ≥3 esophagitis and pneumonitis accounted for 7.5% and 15.0% of all cases, respectively. A higher RT dose (mean dose: 66.6 vs. 61.7 Gy) was significantly correlated with grade ≥3 pneumonitis (p = 0.001). RT modality was a significant factor (p = 0.042, five of six cases occurred in the IMRT group). Conclusions: SCN involvement could negatively affect oncologic outcomes of stage IIIC NSCLC patients. High-dose irradiation with IMRT could increase local control but may cause lung toxicities.

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