Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Abstract

The present study reports two cases of lung cancer with the involvement of the pleura. The diagnosis of adenocarcinoma with epidermal growth factor receptor (EGFR) mutation was made following repeated thoracentesis with cytology of pleural fluid and thoracoscopy with pleural biopsies. Talc pleurodesis was successfully performed in both cases subsequent to diagnosis. Following talc pleurodesis, the first patient (62 years old; male; non-smoker) underwent 3 cycles of cisplatin/vinorelbine chemotherapy, with a poor response. Concurrently, due to the presence of an EGFR mutation, treatment with gefitinib was initiated, with the patient achieving a good response for ~12 months. The residual tumor was treated with stereotactic radiotherapy and the patient continued gefitinib treatment. The patient is presently in good health, has not exhibited any signs of relapse and is continuing gefitinib treatment without side effects. The second patient (53 years old; male ex-smoker) underwent treatment with gefitinib subsequent to talc pleurodesis for a total of 15 months. In addition, radiotherapy (60 Gy) on the residual lesion was performed. Subsequently, second-line therapy with cisplatin/premetrexed was prescribed and followed by maintenance treatment with premetrexed. Three years after diagnosis, the patient did not exhibit any signs of recurrence. These two cases highlight the difficulty in treating advanced stage lung cancer, despite the presence of EGFR mutation. Each lung cancer is different and requires the physician to possess a wide range of knowledge of the therapeutic options available, in addition to careful monitoring in order to adjust the treatment over time. A multidisciplinary approach, involving surgeons, radiation oncologists, pulmonologists and oncologists, is required to optimize the survival and quality of life of patients with lung cancer.

Keywords: chemotherapy; epidermal growth factor receptor mutation; lung cancer; lung cancer survival; radiotherapy; talc pleurodesis.

Figure 1.

Baseline computed tomography scan of patient 1 revealed (A) a massive pleural effusion on the left lung with (B) sub-atelectasis of the lower lobe.

Figure 2.

Computed tomography scans of patient 1 (A) following thoracentesis revealed a good re-expansion of the lung and a lesion in the left lower lobe, (B) which was partially reduced subsequent to 4 cycles of chemotherapy.

Figure 3.

A fuorodeoxyglucose-positron emission tomography-computed tomography scan of patient 1, 6 months after stereotactic radiotherapy, revealed no uptake in the lesion on the lower left lobe of the lung, reduced metabolic activity (standardized uptake value, <3) and residual inflammation in the pleural space.

Figure 4.

A computed tomography scan of patient 2 revealed (A) a pleural effusion and (B) a lesion in the lower left lobe of the lung.

Figure 5.

Subsequent to talc pleurodesis and gefitinb treatment for 6 months, patient 2 underwent (A) a CT scan, revealing a pleural thickening, and (B) a ¹⁸F-FDG-positron emission tomography-CT scan, revealing an increased uptake of ¹⁸F-FDG in the lesion. CT, computed tomography; ¹⁸F-FDG, fuorodeoxyglucose.