Limits...
Long-term survival after surgical treatment of metachronous bilateral adrenal metastases of non-small cell lung carcinoma.

Taira N, Kawabata T, Ichi T, Kushi K, Yohena T, Kawasaki H, Ishikawa K - Am J Case Rep (2014)

Bottom Line: However, on follow-up CT the adrenal lesion was found to have enlarged; therefore, left adrenalectomy was performed.Three years and six months later, he was doing well, with no evidence of recurrence.Conclusions Selected patients with solitary adrenal metastases of NSCLC can benefit from an aggressive treatment approach, even if such metastases are bilateral.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.

ABSTRACT
Background Although resection of the metastases is the treatment of choice for unilateral solitary adrenal metastasis of non-small cell lung carcinoma (NSCLC), the surgical treatment for bilateral adrenal metastases is quite rare, likely due to the coexistence of multiple synchronous metastases at other sites and/or primary adrenal insufficiency following bilateral adrenalectomy. We herein report a rare case of asynchronous metastasis of NSCLC to the bilateral adrenal glands with long-term survival after bilateral adrenalectomy. Case Report A 70-year-old male underwent right upper lobectomy for lung adenocarcinomaT2aN2M0, stageIIIA following induction chemotherapy. Forty-four months later, right adrenalectomy of a right adrenal tumor was performed, which revealed metastatic lung carcinoma. Following the administration of adjuvant chemotherapy, a metastatic tumor was detected in the left adrenal gland. Although there were no other signs of distant metastasis on radiological examinations, he underwent the chemotherapy due to the risk of adrenal insufficiency. However, on follow-up CT the adrenal lesion was found to have enlarged; therefore, left adrenalectomy was performed. Three years and six months later, he was doing well, with no evidence of recurrence. Conclusions Selected patients with solitary adrenal metastases of NSCLC can benefit from an aggressive treatment approach, even if such metastases are bilateral.

Show MeSH

Related in: MedlinePlus

(A) CT performed 1 year after right adrenalectomy shows a left adrenal tumor (2.5×1.6 cm). (B) A PET/CT scan shows a moderate uptake in the tumor, with a maximum SUV of 6.0.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4206476&req=5

f2-amjcaserep-15-444: (A) CT performed 1 year after right adrenalectomy shows a left adrenal tumor (2.5×1.6 cm). (B) A PET/CT scan shows a moderate uptake in the tumor, with a maximum SUV of 6.0.

Mentions: The postoperative pathological stage was downgraded to T1bN0M0, stage IA. The patient received adjuvant chemotherapy after surgery with tegafur (UFT 400 mg/body/day) orally for 4 months. However, we discontinued the UFT treatment due to severe appetite loss, a known adverse effect of UFT. In April 2008, 3 years and 8 months later after surgery, the serum tumor marker CEA level was significantly elevated (7.0 ng/ml). A CT scan demonstrated a nodule in the right adrenal gland measuring 2×1.5 cm in size (Figure 1A). In addition, fluorodeoxyglucose/positron emission tomography (FDG/PET) revealed a moderate uptake in the nodule, with a maximum SUV of 6.7, which was suggestive of metastasis of the lung malignancy (Figure 1B). Since there were no other signs of local recurrence or distant metastasis, right adrenalectomy was performed. A pathological examination confirmed metastasis of the lung adenocarcinoma. After undergoing 4 courses of chemotherapy with cisplatin (80 mg/m2) and docetaxel (60 mg/m2) postoperatively, the patient received regular follow-up with planned CT imaging. In April 2009, 1 year after the right adrenalectomy, the serum tumor marker CEA level was again evaluated (10.9 ng/ml), and an abdominal CT scan showed a mass in the left adrenal gland measuring 2.5×1.6 cm in size (Figure 2A). In addition, FDG/PET revealed a moderate uptake in the nodule, with a maximum SUV of 6.0 (Figure 2B). Although there were no other signs of local recurrence or distant metastasis on radiological examinations, the patient received 2 courses of chemotherapy with cisplatin (80 mg/m2) and docetaxel (60 mg/m2) due to the risk of adrenal insufficiency. However, the adrenal lesion was found to have enlarged on follow-up CT, with an elevated CEA level (33.0 ng/ml); therefore, left adrenalectomy was performed. The patient had an uneventful recovery under steroid replacement therapy. At follow-up 3 years 6 months after bilateral adrenalectomy, he was found to be well, with no evidence of recurrence.


Long-term survival after surgical treatment of metachronous bilateral adrenal metastases of non-small cell lung carcinoma.

Taira N, Kawabata T, Ichi T, Kushi K, Yohena T, Kawasaki H, Ishikawa K - Am J Case Rep (2014)

(A) CT performed 1 year after right adrenalectomy shows a left adrenal tumor (2.5×1.6 cm). (B) A PET/CT scan shows a moderate uptake in the tumor, with a maximum SUV of 6.0.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4206476&req=5

f2-amjcaserep-15-444: (A) CT performed 1 year after right adrenalectomy shows a left adrenal tumor (2.5×1.6 cm). (B) A PET/CT scan shows a moderate uptake in the tumor, with a maximum SUV of 6.0.
Mentions: The postoperative pathological stage was downgraded to T1bN0M0, stage IA. The patient received adjuvant chemotherapy after surgery with tegafur (UFT 400 mg/body/day) orally for 4 months. However, we discontinued the UFT treatment due to severe appetite loss, a known adverse effect of UFT. In April 2008, 3 years and 8 months later after surgery, the serum tumor marker CEA level was significantly elevated (7.0 ng/ml). A CT scan demonstrated a nodule in the right adrenal gland measuring 2×1.5 cm in size (Figure 1A). In addition, fluorodeoxyglucose/positron emission tomography (FDG/PET) revealed a moderate uptake in the nodule, with a maximum SUV of 6.7, which was suggestive of metastasis of the lung malignancy (Figure 1B). Since there were no other signs of local recurrence or distant metastasis, right adrenalectomy was performed. A pathological examination confirmed metastasis of the lung adenocarcinoma. After undergoing 4 courses of chemotherapy with cisplatin (80 mg/m2) and docetaxel (60 mg/m2) postoperatively, the patient received regular follow-up with planned CT imaging. In April 2009, 1 year after the right adrenalectomy, the serum tumor marker CEA level was again evaluated (10.9 ng/ml), and an abdominal CT scan showed a mass in the left adrenal gland measuring 2.5×1.6 cm in size (Figure 2A). In addition, FDG/PET revealed a moderate uptake in the nodule, with a maximum SUV of 6.0 (Figure 2B). Although there were no other signs of local recurrence or distant metastasis on radiological examinations, the patient received 2 courses of chemotherapy with cisplatin (80 mg/m2) and docetaxel (60 mg/m2) due to the risk of adrenal insufficiency. However, the adrenal lesion was found to have enlarged on follow-up CT, with an elevated CEA level (33.0 ng/ml); therefore, left adrenalectomy was performed. The patient had an uneventful recovery under steroid replacement therapy. At follow-up 3 years 6 months after bilateral adrenalectomy, he was found to be well, with no evidence of recurrence.

Bottom Line: However, on follow-up CT the adrenal lesion was found to have enlarged; therefore, left adrenalectomy was performed.Three years and six months later, he was doing well, with no evidence of recurrence.Conclusions Selected patients with solitary adrenal metastases of NSCLC can benefit from an aggressive treatment approach, even if such metastases are bilateral.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.

ABSTRACT
Background Although resection of the metastases is the treatment of choice for unilateral solitary adrenal metastasis of non-small cell lung carcinoma (NSCLC), the surgical treatment for bilateral adrenal metastases is quite rare, likely due to the coexistence of multiple synchronous metastases at other sites and/or primary adrenal insufficiency following bilateral adrenalectomy. We herein report a rare case of asynchronous metastasis of NSCLC to the bilateral adrenal glands with long-term survival after bilateral adrenalectomy. Case Report A 70-year-old male underwent right upper lobectomy for lung adenocarcinomaT2aN2M0, stageIIIA following induction chemotherapy. Forty-four months later, right adrenalectomy of a right adrenal tumor was performed, which revealed metastatic lung carcinoma. Following the administration of adjuvant chemotherapy, a metastatic tumor was detected in the left adrenal gland. Although there were no other signs of distant metastasis on radiological examinations, he underwent the chemotherapy due to the risk of adrenal insufficiency. However, on follow-up CT the adrenal lesion was found to have enlarged; therefore, left adrenalectomy was performed. Three years and six months later, he was doing well, with no evidence of recurrence. Conclusions Selected patients with solitary adrenal metastases of NSCLC can benefit from an aggressive treatment approach, even if such metastases are bilateral.

Show MeSH
Related in: MedlinePlus