Adrenal metastasis from NSCLC

Sat, 11/10/2018 - 19:15

Greetings all,

I'm a medical doctor from Vietnam.

I want to discuss to you about my patient. He is 58 years old, he is hospitalize with chronic coughs symptoms. After he was taken chest CT Scaner and biopsy show results Adenocarcinoma. Then he was taken PET/CT scan:

In right lower lobe lung cancer: Size 4cm, Max SUV: 8.

Right adreanl have Max SUV: 7,8

My patient have no EGFR muntation detacted.

I am doing test: ALK, ROS 1, DP L1.

I want to ask you than i should therapy with chemotherapy or surgery lung cancer and adreanl metastasis before chemotherapy. If my patient have PDL1 > 50%, i can therapy with immunotherapy plus surgery.

Many thanks!

Jim C Forum Mo…

Hi TienDong,

Welcome to GRACE. For legal and practical reasons, we can't advise you which therapy to choose for your patient, but we can discuss the considerations that impact that decision.

The presence of an adrenal metastasis would make this cancer stage IV metastatic lung cancer, with the assumption that cancer cells are present in the bloodstream, in which case local therapy such as surgery is not usually recommended. The reasoning is that even after removing one or more tumors, the remaining cancer cells present in the blood will continue to form additional tumors elsewhere, while the patient will have endured the side effects of surgery with little chance of cure. But if there are no other distant metastases suggested by the PET/CT scan, then it may be wise to biopsy the adrenal mass to verify that it is indeed cancer, as described by Dr. Gerard Silvestri here: https://cancergrace.org/post/pet-scan-imaging-what-does-it-tell-us If the biopsy proves to be negative, then surgery to remove the lung lesion becomes a better option, and cure may be possible. 

Of course every general principal has exceptions, and there is the concept of the oligometastasis. When there is just one, or perhaps a couple of metatastases, it may be advisable to treat them with radiation, as Dr. Jeffrey Bradley describes here: https://cancergrace.org/post/sbrt-oligometastatic-lung-cancer 

Otherwise, systemic therapy such as targeted therapy (if one of the mutations for which you are testing is present), chemotherapy or immuntherapy are appropriate choices.

Best wishes to your patient for successful treatment.

Jim C Forum Moderator

 

TienDong_md

Thank you for your reply.

I chosen chemotherapy for my patient about 3 cycles. It is Carbolatin and Paclitacel plus Bevacizumab.

Jim C Forum Mo…

That's certainly a solid chemotherapy choice, and we hope he does very well. We'd be happy to hear an update after the first follow-up scan.

 

Jim C Forum Moderator