Stage IV lung adenocarcinoma with brain and right shoulder-joint metastases: durable pain relief after SBRT

What happened, in summary

This patient was a 73-year-old man with Stage IV lung adenocarcinoma and brain metastases diagnosed 1 year and 11 months earlier. He developed right shoulder pain that first bothered him while dressing and then worsened over 1 month. A PET/CT scan 8 months before the pain had shown no FDG uptake in the right shoulder joint. After symptoms began, PET/CT showed focal high uptake in the same joint area. The radiology impression suggested scapular metastasis, but CT and MRI showed a contrast-enhanced lesion in the right shoulder joint without surrounding bone abnormalities. Considering his cancer history, new severe pain, rapid progression, and imaging pattern, his doctors diagnosed an intra-articular metastasis of the right shoulder joint. The lesion was treated with stereotactic body radiation therapy. He received 30 Gy in 3 fractions over 4 days, with a treatment volume of 6.1 mL, maximum dose of 46.2 Gy, and treatment time of 32 minutes per fraction. Pain began to improve immediately after the first SBRT session. By the end of treatment, his pain score had fallen from 10 to 4, and 1 week after starting SBRT the shoulder pain had disappeared. Six months later, PET/CT showed no FDG uptake in the treated joint. During the next 8 years and 4 months, PET/CT was performed 6 times without recurrent uptake. At the final examination, 9 years and 3 months after SBRT, right shoulder pain had not returned, and no SBRT-related adverse events had occurred. The durable response was notable because imaging continued to show no recurrent joint uptake across repeated surveillance scans.