Long-term survival of a patient with
stage IV pulmonary large cell carcinoma achieved by combined-modality therapy:
report of a case.
Kobayashi S,
Okada S, Hasumi T, Sato N, Fujimura S
Department of Thoracic
Surgery, Tohoku University, Sendai, Japan.
[Medline record in
process]
We describe herein the case of a 59-year-old-man with stage IV
pulmonary large cell carcinoma and a giant brain metastasis, in whom two
sublines with different growth characteristics and drug sensitivities in vitro
were established from the primary tumor. Disease-free survival for more than 5
years after surgery was achieved by combined-modality therapy together with
surgery to remove the primary tumor, radiation to the brain metastasis, and
chemotherapy to presumed hematogenous dissemination. Subline 1 proliferated in a
monolayer of epithelial-like cells, while subline 2 showed a floating colony
pattern of proliferation, resembling the typical growth characteristics of small
cell lung cancer (SCLC) cells in vitro. Subline 2 was sensitive to a number of
drugs, namely, vincristine (VCR), cyclophosphamide (CPM), adriamycin (ADR), and
cisplatin (CDDP), whereas subline 1 was resistant to many drugs. The patient was
treated with a combination of 44 Gy of whole-brain irradiation and a number of
cycles of chemotherapy comprised of ADR, VCR, and CPM, followed by CDDP, VCR,
and CPM, based on the results of sensitivity testing of the subline 2 cells. As
a result, the patient has been disease-free for more than 5 years
postoperatively. In conclusion, this case report serves to demonstrate that
meticulous combined-modality treatment taking tumor heterogeneity in human
cancers into account may be necessary to achieve breakthroughs in current cancer
therapy for advanced lung cancer.
