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.

Keywords:

• multiple primary lung cancer
• ground-glass opacity
• epidermal growth factor receptor-tyrosine kinases inhibitor
• folate receptor-positive circulating tumor cell
• literature review

Acknowledgments

Bo Cheng, Hongsheng Deng, and Yi Zhao are co-first authors for this study.

Abbreviations

SMPLC, synchronous multiple primary lung cancer; GGO, ground-glass opacity; CR, complete response; FR+CTC, folate receptor-positive circulating tumor cell; CT, computed tomography; LLL, left lower lobe; LUL, left upper lobe; ICIs, immune checkpoint inhibitors; PD‐1, programmed cell death protein 1; NSCLC, non-small cell lung cancer; LUAD, lung adenocarcinoma; MIA, minimally invasive adenocarcinoma.

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author Jianxing He, Email: [email protected].

Consent for Publication

The authors have obtained informed consent from the patient for publication of this case report, and the ethics committee of The First Affiliated Hospital of Guangzhou Medical University approved this consent process and the publication of case details.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declared no conflicts of interest.