Pulmonary Literature Review and Complex Case Presentations Post Graduate Course-Complex Cases Lung Cancer Treatment and Screening Silvestri

Complex Cases Lung Cancer Treatment and Screening Silvestri

Pdf Summary

The document provides a detailed discussion on the diagnosis, staging, and management of lung cancer cases, presenting three complex cases within the field of thoracic oncology.<br /><br />**Case 1** involves a 70-year-old woman with a right lower lobe lung mass, diagnosed as a moderately differentiated adenocarcinoma with an EGFR exon 19 deletion mutation. The PET-CT scan indicated a hypermetabolic mass, but no other FDG-avid sites or lymph involvement. The clinical stage was identified as T2aN0M0, Stage IB. Post lobectomy, the final pathology aligned with the initial findings, and the question posed was about recommending further treatment. The ADAURA trial suggests that adjuvant therapy with osimertinib in stage IB can significantly increase disease-free survival compared to placebo, which may influence the decision for after-surgery treatment.<br /><br />**Case 2** examines the management of a persistent 15mm pure ground glass nodule (GGN) in a patient who continues to smoke. Follow-up CT scans showed no change until 5 years when the nodule increased to 28 mm. The appropriate management of GGNs includes shared decision-making, considering resection or continued monitoring. The question arises about the management approach given the nodule's growth.<br /><br />**Case 3** discusses a 60-year-old former smoker with a detected lung nodule and adrenal gland metastasis, diagnosed with K-ras mutant adenocarcinoma. The appropriate clinical decision hinges on confirming the absence of mediastinal involvement before considering curative surgery, highlighting the importance of invasive mediastinal staging in potential solitary metastasis cases.<br /><br />The document underscores the complexities in lung cancer treatment, integrating imaging, biopsy results, genetic mutations, and clinical trials findings to strategize the management of different pathological and clinical scenarios. While new treatments and trials inform updated management plans, personalized decisions based on patient characteristics and preferences play a critical role.

Keywords

lung cancer

thoracic oncology

adenocarcinoma

EGFR mutation

osimertinib

ground glass nodule

K-ras mutation

mediastinal staging

personalized treatment

clinical trials