Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5540-5546
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5540
Complete pathological response in locally advanced non-small-cell lung cancer patient: A case report
Elisabetta Parisi, Donatella Arpa, Giuglia Ghigi, Simona Micheletti, Elisa Neri, Luca Tontini, Martina Pieri, Antonino Romeo
Elisabetta Parisi, Donatella Arpa, Simona Micheletti, Elisa Neri, Luca Tontini, Martina Pieri, Antonino Romeo, Radiotherapy Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, Italy
Author contributions: Parisi E conceived and designed the study, was involved in data collection, analyzed and interpreted the data, and drafted the manuscript; Arpa D conceived and designed the study and was involved in data collection; Ghigi G, Micheletti S, Neri E, Tontini L and Pieri M were responsible for data collection; Romeo A revised the manuscript for important intellectual content; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s next of kin for inclusion in this report.
Conflict-of-interest statement: The authors declare that they have no conflict interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elisabetta Parisi, MD, Doctor, Radiotherapy Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, Meldola 47014, Italy. elisabetta.parisi@irst.emr.it
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: February 11, 2021
Revised: February 22, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: July 16, 2021
Abstract
BACKGROUND

Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer (NSCLC). We describe the case of a patient with locally advanced node-positive NSCLC (LA-NSCLC) treated in a phase II prospective protocol with chemotherapy, accelerated hypofractionated radiotherapy (AHRT) and surgery in the pre-immunotherapy era.

CASE SUMMARY

A 69-year-old male, ex-smoker (20 PY), with a Karnofsky performance status of 90, was diagnosed with locally advanced squamous cell lung carcinoma. He was staged by total body computed tomography (CT) scanning, and integrated 18F-fluorodeoxyglucose positron emission tomography/CT scan [cT4 cN3 cM0, stage IIIC according to TNM (tumor-node-metastasis) 8th edition] and received AHRT between chemotherapy cycles, in accordance with the study protocol (EudractCT registration 2008-006525-14). At the end of the study the patient underwent surgery, which was not part of the protocol, and showed a complete pathological response.

CONCLUSION

This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement. Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications. We hypothesize that this radiotherapeutic approach, with its proven efficacy, could be delivered as a short course reducing treatment costs, increasing patient compliance and reducing toxicity. We are currently investigating the possibility of combining hypofractionation, chemotherapy and immunotherapy for patients with LA-NSCLC.

Keywords: Locally advanced non-small-cell lung cancer, Hypofractionated radiotherapy, Chemoradiotherapy, Complete pathological response, Immunotherapy, Case report

Core Tip: Non-small-cell lung cancer (NSCLC) represents the most common cause of death from cancer worldwide. The majority of patients present with locally advanced or metastatic disease at diagnosis. Concurrent chemoradiotherapy and immunotherapy is actually the gold standard treatment for this patient setting, with better long-term survival data than previously. As concurrent chemoradiotherapy is characterized by high-grade toxicity, a limited number of lung cancer patients is able to undergo or complete the treatment in clinical practice. We present a patient with NSCLC who was enrolled in a protocol using accelerated hypofractionated radiotherapy and who, after surgery, was staged as no residual oncological disease ypT0ypN0.