Sequential bronchoplastic upper lobectomy as a surgical component of multimodal treatment for synchronous bilateral multiple primary non-small cell lung cancer

Relevance. Lung cancer (LC) is the leading cause of cancer-related death worldwide including Russia. Surgery remains the standard of care for early non-small cell lung cancer (NSCLC). However, as the disease progresses, the risk of metastasis increases, and the effectiveness of surgical intervention decreases. The treatment strategy for patients presenting with a single NSCLC has long been developed. However, for patients with two or more tumors, especially in both lungs, the correct choice is determined by many additional factors. Currently, the view on the surgical treatment for synchronous multiple primary NSCLC has changed dramatically. However, patients with locally advanced synchronous NSCLC often receive conservative treatment, and for those who do undergo surgery, the prognostic factors are unclear. The disease prognosis in patients after surgical treatment for bilateral synchronous multiple primary NSCLC has now been proven to be favorable. Pneumonectomy is believed to have no any negative effect on survival; however, several authors reported on a 1.5-2-fold increase in postoperative mortality in a series of surgeries for synchronous NSCLC. Case description. We herein report a case in which extended bronchoplastic upper lobectomy was successfully applied in the treatment of a patient with bilateral synchronous NSCLC. Our experience demonstrates that the sequential application of modern therapeutic modalities results in satisfactory long-term outcomes in the treatment of locally advanced LC.Conclusion. Due to its uniqueness, this clinical case will be useful for developing treatment strategy for synchronous locally advanced NSCLC as well as for improving the quality of life of patients and increasing their survival.

1. Vladimirova L.Yu., Kit O.I., Sholokhova E.A. The role of histological and molecular analysis in the choice of treatment for advanced non-small cell lung cancer. Pharmateka. 2012; 8(241): 9–22. (in Russian)].

2. Romaszko A.M., Doboszyńska A. Multiple primary lung cancer: A literature review. Adv Clin Exp Med. 2018; 27(5): 725–30. doi: 10.17219/ acem/68631.

3. Tanvetyanon T., Finley D.J., Fabian T., Riquet M., Voltolini L., Kocaturk C., Fulp W.J., Cerfolio R.J., Park B.J., Robinson L.A. Prognostic factors for survival after complete resections of synchronous lung cancers in multiple lobes: pooled analysis based on individual patient data. Ann Oncol. 2013; 24(4): 889–94. doi: 10.1093/annonc/mds495.

4. Griffoen G.H., Lagerwaard F.J., Haasbeek C.J., Smit E.F., Slotman B.J., Senan S. Treatment of multiple primary lung cancers using stereotactic radiotherapy, either with or without surgery. Radiother Oncol. 2013; 107(3): 403–8. doi: 10.1016/j.radonc.2013.04.026.

5. Riquet M., Cazes A., Pfeuty K., Ngabou U.D., Foucault C., Dujon A., Banu E. Multiple lung cancers prognosis: what about histology? Ann Thorac Surg. 2008; 86(3): 921–6. doi: 10.1016/j.athoracsur.2008.05.041.

6. Leyn P. De, Moons J., Vansteenkiste J., Verbeken E., Raemdonck D.V., Nafteux P., Decaluwe H., Lerut T. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg. 2008; 34(6): 1215–22. doi:10.1016/j.ejcts.2008.07.069.

7. Yang H., Sun Y., Yao F., Yu K., Gu H., Han B., Zhao H. Surgical Therapy for Bilateral Multiple Primary Lung Cancer. Ann Thorac Surg. 2016; 101(3): 1145–52. doi: 10.1016/j.athoracsur.2015.09.028.

8. Lazutin Yu.N., Sergostyants G.Z., Pyltsin S.P., Kharitonova A.P., Leyman I.A. Method of treating lung cancer. The patent of the Russian Federation No 2554750. 27.06.2015. (in Russian)].

9. Tanvetyanon T., Robinson L., Sommers K.E., Haura E., Kim J., Altiok S., Bepler G. Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol. 2010; 5(7): 1018–24. doi: 10.1097/JTO.0b013e3181dd0fb0.

10. Voltolini L., Rapicetta C., Luzzi L., Ghiribelli C., Paladini P., Granato F., Gallazzi M., Gotti G. Surgical treatment of synchronous multiple lung cancer located in a diferent lobe or lung: high survival in node-negative subgroup. Eur J Cardiothorac Surg. 2010; 37(5): 1198–204. doi: 10.1016/j.ejcts.2009.11.025.

11. Fabian T., Bryant A.S., Mouhlas A.L., Federico J.A., Cerfolio R.J. Survival after resection of synchronous non-small cell lung cancer. J Thorac Cardiovasc Surg. 2011; 142(3): 547–53. doi: 10.1016/j. jtcvs.2011.03.035.