Stage IV lung squamous cell carcinoma with liver metastasis treated with chemotherapy and 90Y radioembolization

What happened, in summary

This 53-year-old woman had a history of Stage IB left lung squamous cell carcinoma, classified as T2N0M0, treated 2 years earlier with lobectomy and adjuvant carboplatin plus paclitaxel. She later presented with a solid mass on the undersurface of the left tongue. Biopsy showed poorly differentiated squamous cell carcinoma. She underwent wide local excision of the floor of mouth and left tongue, bilateral neck dissection, and flap reconstruction. One month after surgery, she received cisplatin-based chemoradiation with a total radiation dose of 66 Gy. During PET CT surveillance 11 months later, a new 2.8 × 2.4 cm mass appeared in the left hepatic lobe. Ultrasound-guided biopsy confirmed metastatic squamous cell carcinoma consistent with the lung primary tumor, marking progression to Stage IV lung cancer with liver metastasis. She began another chemotherapy regimen with cisplatin, 5-fluorouracil, and cetuximab and was also referred for liver-directed radioembolization. Mapping angiography showed suitable hepatic anatomy and a hepatopulmonary shunt fraction of 5.3%. One month later, 90Y-labeled glass microspheres were delivered through the left hepatic artery, with an approximate 120 Gy radiation dose. She recovered uneventfully and continued the planned 6-cycle chemotherapy regimen. PET CT 2 months after radioembolization showed complete tumor response without residual tumor. At the latest follow-up, she was alive without active disease 16 months after initial diagnosis, 4 months after Stage IV progression, and 2 months after 90Y radioembolization. The multi-step course combined prior lung surgery, treatment of a later oral squamous lesion, systemic therapy, and liver-directed radiation, with the liver biopsy tying the metastatic disease back to the lung primary.