Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review

Abstract

There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR + -CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.

Genetic, DNA methylation, and immune profile discrepancies between early-stage single primary lung cancer and synchronous multiple primary lung cancer

“…Previous studies have described the effectiveness of EGFR-TKI treatment of SPLC patients [ 29 ]. However, only a few studies reported the potency of EGFR-TKI treatment in sMPLC, especially in GGO lesions [ 27 , 30 ]. Given the genetic heterogeneity, coexisting lesions in sMPLC may have a different response to the TKI treatment [ 30 ].…”

“…However, only a few studies reported the potency of EGFR-TKI treatment in sMPLC, especially in GGO lesions [ 27 , 30 ]. Given the genetic heterogeneity, coexisting lesions in sMPLC may have a different response to the TKI treatment [ 30 ]. Ye and colleagues reported lesions’ different responses to TKI treatment before surgery.…”

Calculating the area of white spots on the lungs of patients with COVID-19 using the Sauvola thresholding method

“…The method used was patients with ground glass nodules from March 2016 to October 2019 who had undergone surgery and then monitored their GGO progress based on the extracted CT features. Cheng et al [15] reviewed synchronous multiple primary lung cancer (SMPLC) cases in patients who had undergone surgery and then underwent epidermal growth factor receptor tyrosine kinase inhibitors (EFGR-TKI) within 12 months of surgery. Wang et al [16] in their research, built an objective and accurate prediction in assessing the pathology of GGO by extracting the parameter features of p53 expression.…”

Deep learning analysis to predict EGFR mutation status in lung adenocarcinoma manifesting as pure ground-glass opacity nodules on CT

“…In terms of such a challenging condition, a few reports have shown the potency of molecular targeted therapy, EGFR-TKI as a novel strategy for the treatment of cases with multiple GGNs, and they helped provide a non-invasive therapeutic approach for EGFR-mutated lung adenocarcinoma manifesting as pGGN (12,13). The authors used surgical resection for the major lesion which was the most invasive, and continued EGFR-TKI gefitinib treatment for unresectable GGNs (more than 10mm), and they achieved a complete response (12,13). Additionally, there can be difficulty accessing tissue samples of pGGN through core biopsy due to the potential risk of complications and limitations in pathologic evaluation such as stromal invasion (14,15).…”