Oligometastatic Lung Cancer With Brain Spread, Surgery and Later Recurrence

What happened, in summary

A 62-year-old man and former 70-pack-year smoker was diagnosed with oligometastatic non-small cell lung cancer with a brain metastasis. The brain lesion was treated with stereotactic radiation, followed by anti-PD-L1 immunotherapy. He initially responded, but the lung tumor later began growing again. PET imaging showed a growing right lower-lobe mass with high metabolic activity. He underwent right lower lobectomy and mediastinal lymph-node dissection. Pathology showed sarcomatoid carcinoma with an adenocarcinoma component and no involved lymph nodes. His postoperative course was complicated by a prolonged chest-tube air leak, and he was discharged on postoperative day 11. He initially remained off treatment after surgery. After 15 months, however, the cancer returned with mediastinal nodal and distant metastases. At 25 months after surgery, he was alive with disease and receiving platinum-based chemotherapy.