Metachronous Primary Lung Cancer Research Articles

The long-term outcomes of metachronous tumors for non-small cell lung cancer

BackgroundWe aimed to identify prognostic factors for mortality and survival in patients operated on for metachronous primary lung cancer (MPLC). Materials and methodsThe data of 67 non-small cell lung cancer patients with MPLC, diagnosed and operated upon between January 2000 and December 2015, were retrospectively analyzed. ResultsOf the 67 included patients, 63 (94%) were male and 4 (6%) were female. The overall survival rate after second surgery was 53.6% at 5 years and 34.1% at 10 years. The mean survival time was 64 months (95% confidence interval: 35–92 months). Adjuvant treatment improved survival (p ​= ​0.039). Although the survival of grade N0 and N1 patients did not differ, four grade N2 patients exhibited poor survival (p ​= ​0.02). Cox's regression analysis revealed that grade N2 disease decreased survival 5.3- fold, the absence of adjuvant treatment decreased survival 2 fold and pT4 grade decreased survival 3.4 fold. ConclusionsNew lung tumors may be detected during follow-up of lung cancer patients who have been definitively treated. In such cases, if extrapulmonary metastases and N2 lymphatic involvement are absent, there is no recurrence in the surgical margins of the first operation, and there is only one new tumor, we suggest that surgical treatment should be initially chosen for patients with adequate cardiopulmonary reserves regardless of the time of appearance of the second tumor, whether or not the histopathological type is the same as that of the first tumor.

Second surgery for metachronous primary lung cancer

: As curative surgeries for early-stage non-small cell lung cancer (NSCLC) increase and longer postoperative survival becomes possible, metachronous primary lung cancer (MPLC) have become more common in recent years. Lung cancer survivors have a high risk of MPLC for the rest of their lives, so long-term follow-up and close surveillance are needed. MPLC is often detected relatively early by routine surveillance after the initial surgery, and 64.7% to 85.2% of the cases reported to date have been stage I. Operative mortality after resection of MPLC has been reported to be 0% to 13.0%. Operative morbidity has been reported to be 19.7% to 36.2%. The Five-year overall survival from second surgery was recently reported to be 42% to 78.7%. If the new lesion is solitary and cardiopulmonary function is preserved, complete surgical resection should be considered, regardless of the duration of disease-free survival from initial surgery. Lung-sparing surgery such as segmentectomy or wedge resection and lobectomy have been often reported to have comparable outcomes. Sublobar resection would be acceptable depending on the tumor size and location of the tumor. Because residual pulmonary function is the most important factor for decision-making regarding surgical resection of MPLC, lung preservation should be attempted as much as possible at the time of initial surgery.

P06.01 Therapeutic Strategies for Metachronous Multiple Primary Lung Cancer

It is not uncommon to encounter metachronous primary lung cancer after surgical treatment along with the increase in the elderly patients. In consideration of increasing number of such patients, it is necessary to take various treatment strategies. Method: In order to establish a treatment strategy for multiple lung cancer, we retrospectively examined multiple lung cancer cases operated for primary lung cancer in our department from January 2013 to December 2018, and the future treatment strategy was examined. In order to establish a treatment strategy for multiple lung cancer, we retrospectively examined multiple lung cancer cases operated for primary lung cancer in our department from January 2013 to December 2018, and the future treatment strategy was examined. Of 821 patients who underwent surgery for primary lung cancer, 60 were multiple lung cancers, 31 were synchronous multiple lung cancers, and 29 were metachronous multiple lung cancers. Among the cases of metachronous multiple lung cancer, 27 cases had undergone lobectomy or more in the first operation, 1 case of segmental resection, and 1 case of partial resection. As for the treatment of secondary lung cancer lesions, 20 lesions were performed surgery (lobectomy; 1, segmental resection;5, partial resection; 14), 6 lesions of photodynamic therapy (PDT), and 3 lesions of SBRT. Among the surgical cases, there were 3 cases on the same side as the first cancer and 17 cases on the opposite side. The three cases underwent partial resection. Among 17 patients, postoperative home oxygen therapy was introduced in 2 patients. Regarding the prognosis, three patients who had surgical resection, died of recurrence of the first lesion. Two of the six PDT patients died of recurrence of the first lung cancer and one died of other disease. All three patients who underwent SBRT are alive without recurrence. If early detection and early diagnosis are made as a treatment strategy for metachronous multiple lung cancer, it may be possible to preserve lung function by reducing surgery or SBRT, PDT, and to cure without damaging the quality of life.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography

ObjectiveLung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. MethodsWe conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. ResultsNinety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. ConclusionLung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Metachronous, Ipsilateral Primary Lung Cancer: A Case Report

Lung cancer is the most common malignant tumor in men worldwide. It has been documented that patients can develop multiple primary lung cancer, with a 5% annual risk of a second primary (metachronous) cancer occurring after prior curative treatment. Moreover, there has been an increase in the incidence of metachronous primary lung cancer reflecting a longer survival after curative resection of the primary cancer and improvements in patient surveillance methods. Herein, we present a case of a patient diagnosed with a metachronous primary lung cancer presenting 1 year after treatment of a primary lung cancer at National Chest Hospital, Kingston, Jamaica. Through strict adherence to surveillance guidelines, this metachronous cancer was detected, enabling the patient to be promptly treated.

Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis.

We compared outcomes after surgery or stereotactic body radiotherapy (SBRT) among patients with metachronous primary lung cancer (MPLC). Patients with MPLC were treated with either surgery (2008-2018) or SBRT (2010-2018). We used propensity score matching (PSM) to reduce bias from various clinicopathological factors. MPLC was defined by the Martini and Melamed criteria. Of 77 patients, 51 underwent surgery and 26 received SBRT. Most median clinicopathological characteristics did not significantly differ between the surgery and SBRT groups (male sex: 67% vs 65%; age: 73 vs 77years; time after first surgery: 6.2 vs 4.7years; lobectomy as first procedure: 82% vs 85%; second tumor size: 11 vs 12mm; clinical stage I: 96% vs 100%; CEA: 2.9 vs 3.0ng/ml). However, the surgery group had significantly more ipsilateral second tumors (n = 71, 58%, P = 0.003), better performance status (P = 0.03), and preserved lung function (P = 0.02). Surgery, thus, tended to be selected for patients with good physical function and for the MPLC in the contralateral side. Five-year overall survival did not significantly differ between the surgery and SBRT groups, either before PSM (86.5% vs 65.8%, P = 0.24, log-rank) or after PSM (100% vs 84.4%, P = 0.73). Surgery and SBRT for MPLC patients are safe and feasible treatments with similar outcomes. However, this finding should be verified by a random controlled trial with a larger study cohort.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography

ObjectiveLung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. MethodsWe conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. ResultsNinety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. ConclusionLung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Metachronous NSCLC in previously irradiated patients: is re-irradiation with SBRT a good option as definitive treatment?

AbstractAim:Treatment of metachronous second primary non-small cell lung cancer (NSCLC) in patients already treated with definitive radiotherapy is a matter of debate, since most patients are excluded from surgical treatment, which remains a therapeutic standard for patients with isolated lung masses. Salvage chemotherapy or immunotherapy alone offers a low probability of disease control. The option of re-irradiation often remains the only viable, but the risks of severe acute or late toxicities affecting the surrounding normal tissues make this a real clinical challenge.Materials and methods:From January 2015 to April 2018, five patients (male/female: 4/1; age 54–81 years, median 68) with previously irradiated NSCLC presented with a second primary lung tumour.Results:A partial response was seen in four patients, one complete responses in the fifth. The toxicity was low: two patients experienced a grade 2 asymptomatic radiation pneumonitis after 6 and 12 months from the end of stereotactic body radiation therapy, resolved with cortisone therapy. No acute or late oesophageal or cardiac toxicity was found.Findings:In this work, we present our initial experience about the use of stereotactic radiotherapy technique in already irradiated patients. We reported a local disease control in all cases with an acceptable toxicity.

Metachronous or synchronous primary lung cancer in the era of computed tomography surveillance

ObjectivesThe purpose of this study was to determine the frequency, characteristics, and survival of second primary lung cancer initially identified as an indeterminate lesion on the original computed tomography scan and then diagnosed during the surveillance period in a prospective study. MethodsA prospective database of 271 patients enrolled in a surveillance study was updated. Indeterminate lesions present on the original computed tomography at the time of initial primary lung cancer diagnosis that subsequently grew and were diagnosed as cancer were termed “synchronous primary lung cancer.” Lesions that were not present on the original computed tomography scan and subsequently diagnosed on surveillance were termed “metachronous primary lung cancer.” ResultsThirty patients (11.1%) developed 37 second primary lung cancers over a median surveillance period of 84.7 (range, 15.9-147.6) months. Of these, 15 of 37 (40.5%) were identified as synchronous primary lung cancer, and 22 of 37 (59.5%) were identified as metachronous primary lung cancer. At first identification, ground-glass lesions were identified in 9 of 15 (60%) synchronous primary lung cancers compared with only 5 of 22 (22.7%) of metachronous primary lung cancers (P = .034). Compared with metachronous primary lung cancer, from first identification to diagnosis, synchronous primary lung cancer developed over a longer interval (33.6 vs 7.2 months, P = .001) and had a slower growth rate (0.17 vs 0.45 mm/month, P = .027). The 5-year overall survival from second lung cancer was 73.0%. No significant differences were observed between the synchronous primary lung cancer and metachronous primary lung cancer cohorts in overall survival from initial primary lung cancer (P = .583) or from second lung cancer (P = .966). ConclusionsComputed tomography surveillance identifies 2 types of curable second lung cancers leading to excellent overall survival.

Non-small cell to small cell lung cancer on PD-1 inhibitors: two cases on potential histologic transformation.

IntroductionHistologic transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) is a well-recognized mechanism of resistance in EGFR-mutant adenocarcinoma upon treatment with TKIs, but rarely reported with programmed death1 (PD-1) inhibitors. We report two cases of potential transformation during treatment with PD-1 inhibitors.Case presentationsCase 1, a 65-year-old man was diagnosed with stage IVa lung adenocarcinoma on pleural fluid cytology. He received six cycles of carboplatin and pemetrexed, then maintained on pemetrexed. He had disease progression after nine cycles of pemetrexed and was switched to nivolumab. He progressed after five cycles of nivolumab. Core biopsy of the lung mass revealed SCLC. Case 2, a 68-year-old man was diagnosed with two primary NSCLCs and underwent resection. He had recurrence after several months and was treated with four cycles of carboplatin, paclitaxel, and pembrolizumab on clinical trial, with partial response. He was continued on pembrolizumab and had disease progression after 30 cycles. Biopsy of the new lesions showed SCLC.DiscussionHistologic transformation from NSCLC to SCLC can be explained by the presence of a common cell precursor. Proposed molecular mechanisms include loss of RB1, TP53 mutations, and MYC amplification. The distinction between transformation and mixed histology tumors is challenging, especially when pathologic material used for the initial diagnosis is limited. The possibility of a second metachronous primary lung cancer cannot be excluded in our cases.ConclusionHistologic transformation with PD-1 inhibitors could be under-recognized. Disease progression should prompt re-biopsy to uncover new histology and change in treatment. Future studies are needed to elucidate mechanisms and predictors of transformation.

Surgical Resection and Outcome of Synchronous and Metachronous Primary Lung Cancer in Breast Cancer Patients.

Women with breast cancer are at increased risk of subsequent primary malignancies, specifically lung cancer. The aim of this study was to report the frequency of lung cancer in patients with breast cancer, and patients' characteristics and surgical outcomes. We investigated 1,066 consecutive female patients undergoing surgical resection for breast cancer and 666 undergoing surgical resection for lung cancer. Lung cancer with breast cancer was observed in 14 patients (1.3% of breast cancer and 2.1% of lung cancer cases; mean age=65 years), and 3/14 (21.4%) patients were smokers. Sixteen lung cancer lesions in 14 patients were adenocarcinomas and one was squamous cell carcinoma. All 14 patients were alive at the time of this report; 4/14 (28.6%) patients had recurrent breast cancer and 1/14 (7.1%) had recurrent lung cancer. In synchronous cases, 5/6 (83.3%) patients received concomitant surgery for both breast cancer and lung cancer. Patients' postoperative courses were uneventful. In metachronous cases, eight patients had lung cancer a mean of 33 months after breast cancer surgery. All eight patients received adjuvant therapies and 4/8 (50%) patients received adjuvant therapies for recurrent breast cancer, including chemotherapy, radiotherapy, hormonal therapy, and anti-HER2 therapy. All patients had early-stage lung adenocarcinoma and underwent surgical resection. Concomitant surgery for synchronous lung and breast cancer was feasible and safe. In metachronous cases, lung cancers tended to be detected within 3 years after surgery for breast cancer. Careful follow-up for postoperative breast cancer may contribute to the detection of early-stage lung cancer.

Triple synchronous primary lung cancer: a case report and review of the literature

BackgroundMultiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous multiple primary lung cancer describes multiple lung lesions that develop at different times, typically following treatment of the primary lung cancer. Patients with previously treated lung cancer are at risk for developing metachronous lung cancer, but with the success of computed tomography and positron emission tomography, the ability to detect both synchronous and metachronous lung cancer has increased.Case presentationWe present a case of a 63-year-old Hispanic man who came to our hospital for evaluation of chest pain, dry cough, and weight loss. He had recently been diagnosed with adenocarcinoma in the right upper lobe, with a poorly differentiated carcinoma favoring squamous cell cancer based on bronchoalveolar lavage of the right lower lobe for which treatment was started. Later, bronchoscopy incidentally revealed the patient to have an endobronchial lesion that turned out to be mixed small and large cell neuroendocrine lung cancer. Our patient had triple synchronous primary lung cancers that histologically were variant primary cancers.ConclusionsTriple synchronous primary lung cancer management continues to be a challenge. Our patient’s case suggests that multiple primary lung cancers may still occur at a greater rate than can be detected by high-resolution computed tomography.

Standardized uptake value and radiological density attenuation as predictive and prognostic factors in patients with solitary pulmonary nodules: our experience on 1,592 patients.

Multislice computed tomography (MSCT) increased detection of solitary pulmonary nodules (SPNs), changing the management based on radiological and clinical factors. When 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) was considered for the evaluation of nodules, the maximum standardized uptake value (SUVmax) more than 2.5 is used frequently as a cut off for malignancy. The purpose of this study is to evaluate SUVmax PET/CT and pulmonary attenuation patterns at MSCT in patients with SPN according to morphological and pathological characteristics of the lesion. A retrospective study on 1,592 SPN patients was carried out following approval by the Italian Registry of VATS Lobectomies. All patients underwent VATS lobectomy. On histologic examination, 98.1% had primary or second metachronous primary lung cancers. In addition, 10.7% presented occult lymph node metastases (pN1 or pN2) on histological examination. Nodule attenuation on CT was associated with the histology of the lesion (p= 0.030); in particular, pure ground glass opacities (pGGOs) and partially solid nodules were related to adenocarcinomatous histotypes. Conversely, a significant relationship between SUVmax and age, nodule size, pathological node status (pN) was found (P=0.007, P=0.000 and P=0.002 respectively). Nodule attenuation can predict the histology of the lesion whereas SUVmax may relate to the propensity to lymph node metastases.

Outcomes for patients with synchronous and metachronous primary lung cancer after diagnosis of head and neck cancer.

Not-infrequently patients with head and neck cancer are also diagnosed with synchronous lung cancer or metachronous primary lung cancer, which complicates the treatment decisions and prognosis. Patients were identified from a database of patients with head and neck cancer with second primary non-small cell lung cancer (NSCLC). Thirty-four eligible patients (15 with synchronous lung cancer and 19 with metachronous lung cancer) were identified. Thirteen of 15 patients with synchronous lung cancer received curative intent treatment for head and neck cancer first. Six of 15 patients were in complete remission, 5 of 15 patients had died, and 4 were alive with progressive disease. Median time between 2 diagnoses was 47 months in the metachronous lung cancer group. Twelve patients had died, 3 were alive with disease, and 4 were lost to follow-up. Median survival from the time of lung cancer diagnosis was 13 months with a trend to better survival with synchronous lung cancer (15 vs 11 months; p = .11). Aggressive multidisciplinary management of second primary lung malignancies in patients with head and neck cancer can result in respectable long-term disease control particularly in patients with synchronous lung cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1544-1549, 2017.

Targeted sequencing may facilitate differential diagnostics of pulmonary tumours: a case series

BackgroundHistopathological diagnosis is important for prognostication and choice of treatment in patients with cancer in the lung. Metastases to the lungs are common and need to be distinguished from primary lung cancer. Furthermore, cases with synchronous or metachronous primary lung cancers (although infrequent) are often handled differently than cases with lung cancer with intrapulmonary metastasis or relapse, respectively. In some cases, morphology and immunohistochemical staining is not sufficient for certain diagnosis.MethodsThe present study included six cases where molecular genetic analysis in form of pyrosequencing or targeted next-generation sequencing was of value for certain diagnosis of selected tumours in the lung.ResultsTwo of the included cases were rare metastases to the lung; colorectal cancer with IHC profile consistent with primary lung cancer and malignant adenomyoepithelioma of the breast, respectively, where molecular genetic analysis was of aid for proving the relationship to the primary tumour. The other four cases were multiple lung adenocarcinomas where molecular genetic analysis was of aid to distinguish between intrapulmonary metastasis and synchronous tumour.ConclusionsComparison of molecular genetic profile may be an important tool for determination of relationship between tumours in some situations and should always be considered in unclear cases. Further studies on concordance and discordance of molecular genetic profiles between spatially or temporally different tumours with common origin may be helpful for improved diagnostics of pulmonary tumours.

P1.02-066 Genomic Profiling in the Differential Diagnostics of Pulmonary Tumors: A Case Series

Histopathological diagnosis is important for prognostication and choice of treatment in patients with cancer in the lung. Lung metastases are common and need to be distinguished from primary lung cancer. Furthermore, cases with synchronous or metachronous primary lung cancers (although infrequent) are often handled differently than cases with lung cancer with intrapulmonary metastasis or relapse, respectively. In some cases, morphology and immunohistochemical (IHC) staining is not sufficient for certain diagnosis. Five cases were selected where molecular genetic analysis in form of pyrosequencing or targeted next-generation sequencing (NGS) was of value, not only for treatment prediction, but for certain diagnosis of tumors in the lung. Two of the included cases were rare metastases to the lung – rectal cancer with IHC profile consistent with primary lung cancer and malignant myoepithelioma of the breast, respectively – where molecular genetic analysis was of aid for proving the relationship with the primary tumor. The other three cases had multiple lung adenocarcinomas with similar morphology where molecular genetic analysis was of aid to distinguish between an intrapulmonary metastasis and a synchronous primary tumor. Comparison of molecular genetic profile may be an important tool for determination of relationship between tumors, at least in some situations, and should always be considered in unclear cases. Further studies on concordance and discordance of molecular genetic profiles between spatially or temporally different tumors with common origin may be helpful for improved diagnostics of pulmonary tumors.

Metakron primer akciğer kanserleri: Hayat boyu takibin önemi

Metakron primer akciğer kanserleri: Hayat boyu takibin önemi

Pleura and lung

Incidental pulmonary nodules in patients that are imaged for staging purposes or during follow-up may represent metastases, second primary tumours (lung cancer) or benign nodules. The probability of pulmonary metastases or primary lung cancer differs depending on the number, size, size distribution and morphology of the nodules as well as the histologic type, stage, grade and other features of the known malignancy. A large proportion of pulmonary nodules in patients with known cancer are benign. Thus, an unconfounded diagnosis of pulmonary metastases has to be avoided in order not to falsely preclude potentially curative therapy of the primary tumour. Synchronous or metachronous second primary lung cancers in a patient with a known lung cancer have to be differentiated from pulmonary satellite nodules representing either advanced tumour stages or metastatic disease as they may be amenable to curative surgery. Pulmonary consolidation or ground glass attenuation most often represents infection and other non-malignant pathology but may occasionally be due to malignant lesions. Pleural effusions and focal or diffuse pleural thickening from benign causes need to be differentiated from lesions representing pleural carcinomatosis which represents metastastic disease. During this course examples of different incidental pulmonary and pleural lesions will be demonstrated and recommendations and guidelines for the management of the findings will be presented.

P3-13-2 - Feasibility of Stereotactic Body Radiation Therapy with Concurrent Chemotherapy for Metachronous Primary Lung Cancer

Background: Patients with lung cancer may develop a second primary lung cancer after treatment of the initial lesion (metachronous PLC). In those cases, it is difficult to distinguish primary lung cancer from lung metastasis. Therefore, we need both local therapy for a single lung lesion, and systemic therapy for micrometastasis. Stereotactic body radiation therapy (SBRT) is now the standard treatment for patients with inoperable Stage I non-small-cell lung cancer (NSCLC). However SBRT with concurrent chemotherapy may be feasible and effective for selected patients with NSCLC. This retrospective study was aimed at evaluating the safety and tolerability of concurrent SBRT and chemotherapy in patients with metachronous primary lung cancer.Methods: We reviewed the records of 10 patients with metachronous primary lung cancer treated with SBRT and concurrent chemotherapy with curative intent from 2007 to 2013. All patients had T1 tumor. The median age was 65 years with a range of 58 to 79 years. The median delivered radiation dose was 48 Gy in 4 fractions. Concurrent chemotherapy regimen was cisplatin plus docetaxel, cisplatin plus vinorelbine, nedaplatin plus docetaxel, carboplatin plus docetaxel, and carboplatin plus paclitaxel, carboplatin plus docetaxel.Results: All patients received SBRT on schedule. Concurrent chemotherapy was successfully accomplished as originally planned in 10 patients. Initial effect of SBRT plus chemotherapy could be evaluated in all cases. Complete local remission was achieved in 9 patients and Partial local remission was achieved in one patient. Local recurrence were not observed in any patient. Only one patient alone had distant metastases. A grade 3 or 4 neutrophil count decreased occurred in 7 patients, grade 3 febrile neutropenia in 2 patients, and grade3 anemia in one patient. No treatment-related deaths were observed.Conclusion: Our study showed good feasibility and safety of SBRT and concurrent chemotherapy.

A Case of Three Different Synchronous and Metachronous Primary Lung Cancers

Multiple primary lung cancers are characterized as either synchronous (detected or resected simultaneously) or metachronous (defined by a time interval between the detection of a subsequent primary lesion). The diagnosis of multiple primary lung cancers requires the temporal, histologic, and anatomic classification of tumors or simultaneous detection of two tumors. The incidence of multiple primary lung cancers has been increasing recently due to the widespread use of imaging modalities and life extension. Here, we report a 65-year-old male patient with multiple primary lung cancers comprising three different cell types (adenocarcinoma, squamous cell carcinoma, and small cell carcinoma). (Korean J Med 2013;85:639-643)