2018 Volume 32 Issue 5 Pages 641-646
A 51-year-old male with left shoulder pain visited a physician. He was diagnosed with a left superior sulcus tumor, stage IIB (cT3N0M0). Carbon ion radiotherapy (CIRT) was performed at his request. He was given 72 Gray in 16 fractions for the primary tumor. CT after CIRT showed a reduced and scarred primary tumor. However, after one year and two months, he was diagnosed with left mediastinal lymph node (#5) recurrence and transferred to our hospital for chemotherapy. We decided that this case was operable and after one year and four months of CIRT, surgery was performed. Local pleural adhesion between the left apex and chest wall was successfully dissected. Because the #5 lymph node markedly adhered to the pulmonary artery, we performed left upper lobectomy with pulmonary artery plasty. Microscopically, the primary site became a scarred lesion, and no tumor cells were observed. Therefore, we diagnosed his histological response as Ef. 3. There was no evidence of CIRT-related change, such as fibrosis, surrounding the primary site. Only the #5 lymph node had developed a metastasis of squamous cell carcinoma, and we considered it to be ypT0N2M0-Stage IIIA. The surgical and pathological findings confirmed the superior dose localization of CIRT. When patients can be provided with standard therapies, physicians should carefully consider the indications for CIRT.
