Stage IIIA pleomorphic lung cancer treated with surgery, chemotherapy, and radiation

What happened, in summary

This 35-year-old Japanese man presented with 6 months of left back pain. Chest X-ray and CT showed a 43 × 34 mm tumor in the S1+2 region of the left lung. MRI showed that the tumor had invaded the third thoracic vertebra and the third rib. Whole-body CT and bone scintigraphy did not identify nodal or distant metastasis, so the cancer was staged clinically as cT4N0M0, Stage IIIA. Because the tumor had invaded the vertebra and was at risk for major bleeding during surgery, the team first performed arterial embolization of the first, second, and third intercostal arteries that were feeding the tumor. He then underwent complete resection, including left upper lobe lobectomy, lymph node resection, partial resection of the second and third ribs, and total en bloc spondylectomy of the third thoracic vertebra. Final pathology confirmed pleomorphic carcinoma of the lung, pT4N0M0, Stage IIIA, with all resection margins free of malignant cells. After surgery, he received 3 cycles of cisplatin plus docetaxel, followed by oral S-1 and radiation to the primary tumor field. This was locally advanced lung cancer with direct invasion into nearby bone structures, not metastatic disease. At 14 months after surgery, he was alive with no evidence of tumor recurrence. The case shows aggressive local treatment for a rare lung cancer subtype invading the spine and rib. The spine operation was extensive because the tumor directly invaded the third thoracic vertebra, but this was treated as contiguous local extension rather than distant bone metastasis. Negative margins and pT4N0M0 staging were central to the aggressive curative-intent plan.