Volume 55 (2015) Issue 6 Pages 1019-1023
Background. Advances in research of the genes responsible for non-small cell lung cancer, especially adenocarcinoma, have now made it possible to select effective therapeutic agents, i.e., an anaplastic lymphoma kinase (ALK) inhibitor (crizotinib), in patients with the echinoderm microtubule associated protein like 4 (EML4)/ALK fusion gene. We herein report a case of bulky N2 lung cancer that was treated with crizotinib followed by surgery. Case. A 34-year-old man visited our hospital for an evaluation of abnormal shadows on a chest radiograph taken during a medical checkup. Chest computed tomography (CT) showed a nodule measuring 9 mm in diameter in the periphery of the right lower lobe and enlarged lymph nodes in the bifurcation of the trachea (#7) and between the lobar bronchi (#11i). Endobronchial ultrasound-guided transbronchial needle aspiration revealed adenocarcinoma in the lymph node (#7), and the patient was positive for the EML4/ALK fusion gene. He was diagnosed with cT1aN2M0, Stage IIIA lung cancer and thus was started on oral crizotinib. Two months after the start of this treatment, chest CT showed a reduction in the lung nodule and lymph nodes (#7, #11i) by 55%, thus leading to a decision to perform surgery. Right middle and lower lobectomy and lymph node dissection were performed. The pathological diagnosis was adenocarcinoma with mixed subtypes, ypT1aN1M0 Stage IIA, Ef.2. The patient has remained disease-free for 9 months, to date, since the surgery. Conclusion. We herein presented a patient with EML4/ALK fusion gene-positive lung cancer who was treated with ALK inhibitor followed by surgery. When treating cases of unresectable advanced lung cancer, it may still be possible to perform surgery after tumor shrinkage.