Author of

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11031

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    P1.24-030 - A rare case of synchronous and metachronous lung cancers (ID 2238)

    09:30 - 16:30  |  Author(s): P.Q.L. Bui
    • Abstract

    Background
    Multiple primary lung tumours can be either synchronous or metachronous. Clarification between synchronous primary tumours and metastatic lesions is vital given the differing prognosis and therapeutic options. We present a case of a patient with a combination of synchronous and metachronous primary lung malignancies, who did well because she had careful multidisciplinary follow-up.

    Methods
    Not applicable

    Results
    A 63-year-old female ex-smoker, with history of moderately severe chronic obstructive pulmonary disease but good performance status, was found to have pulmonary nodules in the left upper and lower lobes that increased slightly in size over 2 years on serial thoracic CT scans. On FDG-PET, the lesion in the left upper lobe demonstrated marked FDG-avidity (SUVmax 7.5) while the left lower lobe nodule demonstrated much lower FDG uptake (SUVmax 2.5). These were considered synchronous early-stage lung tumours by consensus of our multidisciplinary lung cancer group. Intra-operatively, frozen sections confirmed malignancy in each lesion and the patient successfully underwent wide local excision of both nodules. Histopathology revealed infiltrating moderately differentiated adenocarcinoma in the left upper lobe (T1N0M0) and infiltrating undifferentiated large cell carcinoma in the left lower lobe with no hilar or mediastinal nodal involvement (T1N0M0). The patient remained disease-free until 6 years later, when new right lung opacities were found incidentally on a chest radiograph. Chest CT confirmed 2 new pulmonary nodules in the right upper lobe, one intensely FDG-avid (SUVmax 11.0) and the other poorly avid (SUVmax 1.2). No other FDG-avid foci suspicious of metastatic disease were detected elsewhere. Following multidisciplinary discussion, wedge resections of both lesions were performed. Histopathology revealed high-grade neuroendocrine carcinoma (small and large cell types) in the intensely FDG-avid lesion and adenocarcinoma in situ in the other lesion. The patient was subsequently offered adjuvant chemotherapy and prophylactic whole brain irradiation.

    Conclusion
    This rare case of synchronous and metachronous primary lung cancers illustrates the importance of long-term follow up of patients with previously treated non-small cell lung with curative intent. These patients may develop new metachronous early-stage lung tumours that would benefit from aggressive treatment. New lung opacities may not necessarily represent recurrent metastatic disease with poor prognosis.