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Aggressive Trimodality Therapy for T1N2M1 Nonsmall Cell Lung Cancer with Synchronous Solitary Brain Metastasis: Case Report and Rationale.

Showalter TN, Lin A - Case Rep Med (2010)

Bottom Line: Involvement of mediastinal lymph nodes is considered a poor prognostic factor and a contraindication to surgical resection of the primary lung tumor after treatment for brain metastasis.Here we present the case of a patient who presented with a Stage IV T1N2M1 non-small cell lung cancer with synchronous solitary brain metastasis.He is alive and without evidence of disease two years after aggressive, multimodality treatment that included craniotomy, whole-brain radiation therapy, thoracic surgery, chemotherapy, and mediastinal radiation therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USA.

ABSTRACT
Aggressive treatment, including resection of both metastasis and primary tumor, has been studied for non-small cell lung cancer patients with synchronous solitary brain metastasis. Involvement of mediastinal lymph nodes is considered a poor prognostic factor and a contraindication to surgical resection of the primary lung tumor after treatment for brain metastasis. Here we present the case of a patient who presented with a Stage IV T1N2M1 non-small cell lung cancer with synchronous solitary brain metastasis. He is alive and without evidence of disease two years after aggressive, multimodality treatment that included craniotomy, whole-brain radiation therapy, thoracic surgery, chemotherapy, and mediastinal radiation therapy.

No MeSH data available.


Related in: MedlinePlus

Axial, T1-weighted, postcontrast MR images of the brain. (a) A 2.3 × 2.3 × 2.5 cm left cerebellar lesion occurred synchronous with the diagnosis of a primary NSCLC. (b) The left cerebellar lesion was completely removed through a left suboccipital craniectomy. (c) No residual enhancement is noted after WBRT. (d) There is no evidence of recurrent brain metastasis on MRI obtained 2 years after diagnosis.
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fig1: Axial, T1-weighted, postcontrast MR images of the brain. (a) A 2.3 × 2.3 × 2.5 cm left cerebellar lesion occurred synchronous with the diagnosis of a primary NSCLC. (b) The left cerebellar lesion was completely removed through a left suboccipital craniectomy. (c) No residual enhancement is noted after WBRT. (d) There is no evidence of recurrent brain metastasis on MRI obtained 2 years after diagnosis.

Mentions: A 52-year-old male presented to medical attention with severe headaches. Magnetic resonance imaging (MRI) revealed an enhancing, intra-axial mass in the left cerebellum, measuring 2.3 × 2.3 × 2.5 cm and accompanied by surrounding edema (Figure 1(a)). A CT of the chest, abdomen, and pelvis was performed, revealing a left upper lobe lung mass with ipsilateral hilar and mediastinal lymphadenopathy. The suspected clinical diagnosis was lung cancer with brain metastasis. He underwent a suboccipital craniectomy for removal of the brain lesion. Postoperative MRI demonstrated gross total resection of the brain metastasis (Figure 1(b)). Pathology showed metastatic, poorly differentiated adenocarcinoma, with immunohistochemical findings consistent with a primary lung tumor (TTF-1 and CK7 positive). Whole-brain radiation therapy (WBRT) was administered postoperatively, consisting of 2.5 Gy daily fractions to 37.5 Gy, delivered with opposed lateral portals.


Aggressive Trimodality Therapy for T1N2M1 Nonsmall Cell Lung Cancer with Synchronous Solitary Brain Metastasis: Case Report and Rationale.

Showalter TN, Lin A - Case Rep Med (2010)

Axial, T1-weighted, postcontrast MR images of the brain. (a) A 2.3 × 2.3 × 2.5 cm left cerebellar lesion occurred synchronous with the diagnosis of a primary NSCLC. (b) The left cerebellar lesion was completely removed through a left suboccipital craniectomy. (c) No residual enhancement is noted after WBRT. (d) There is no evidence of recurrent brain metastasis on MRI obtained 2 years after diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821649&req=5

fig1: Axial, T1-weighted, postcontrast MR images of the brain. (a) A 2.3 × 2.3 × 2.5 cm left cerebellar lesion occurred synchronous with the diagnosis of a primary NSCLC. (b) The left cerebellar lesion was completely removed through a left suboccipital craniectomy. (c) No residual enhancement is noted after WBRT. (d) There is no evidence of recurrent brain metastasis on MRI obtained 2 years after diagnosis.
Mentions: A 52-year-old male presented to medical attention with severe headaches. Magnetic resonance imaging (MRI) revealed an enhancing, intra-axial mass in the left cerebellum, measuring 2.3 × 2.3 × 2.5 cm and accompanied by surrounding edema (Figure 1(a)). A CT of the chest, abdomen, and pelvis was performed, revealing a left upper lobe lung mass with ipsilateral hilar and mediastinal lymphadenopathy. The suspected clinical diagnosis was lung cancer with brain metastasis. He underwent a suboccipital craniectomy for removal of the brain lesion. Postoperative MRI demonstrated gross total resection of the brain metastasis (Figure 1(b)). Pathology showed metastatic, poorly differentiated adenocarcinoma, with immunohistochemical findings consistent with a primary lung tumor (TTF-1 and CK7 positive). Whole-brain radiation therapy (WBRT) was administered postoperatively, consisting of 2.5 Gy daily fractions to 37.5 Gy, delivered with opposed lateral portals.

Bottom Line: Involvement of mediastinal lymph nodes is considered a poor prognostic factor and a contraindication to surgical resection of the primary lung tumor after treatment for brain metastasis.Here we present the case of a patient who presented with a Stage IV T1N2M1 non-small cell lung cancer with synchronous solitary brain metastasis.He is alive and without evidence of disease two years after aggressive, multimodality treatment that included craniotomy, whole-brain radiation therapy, thoracic surgery, chemotherapy, and mediastinal radiation therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USA.

ABSTRACT
Aggressive treatment, including resection of both metastasis and primary tumor, has been studied for non-small cell lung cancer patients with synchronous solitary brain metastasis. Involvement of mediastinal lymph nodes is considered a poor prognostic factor and a contraindication to surgical resection of the primary lung tumor after treatment for brain metastasis. Here we present the case of a patient who presented with a Stage IV T1N2M1 non-small cell lung cancer with synchronous solitary brain metastasis. He is alive and without evidence of disease two years after aggressive, multimodality treatment that included craniotomy, whole-brain radiation therapy, thoracic surgery, chemotherapy, and mediastinal radiation therapy.

No MeSH data available.


Related in: MedlinePlus