Video-assisted thoracoscopic surgery right upper lobectomy after neoadjuvant targeted therapy

A 64-year old male patient complained of cough phlegm for half a month. CT scan and PET/CT suggested that a 2-cm nodule in the right upper lobe. At the same time, enlargement of lymph nodes in No. two and No. four was found, and metastasis was considered. A mediastinoscopy had been completed. The biopsy suggested that No. 2 lymph nodes (2/2) and No. 4 lymph nodes (3/3) were positive. The HE coloration was consistent with low-differentiated adenocarcinoma. Gene test suggested the EGFR 19 exon deletion mutation. The patient was diagnosed with lung cancer (pT1N2M0, stage IIIA). Due to refusing chemotherapy, the patient was treated with gefitinib (Iressa) directly as neoadjuvant therapy. Two months after, dramatic regression of the primary nodule and lymph nodes had been showed on the CT scan. The patient had a strong willingness to have a surgical procedure, and then, a three ports video-assisted thoracoscopic surgery (VATS) lobectomy had been completed with an uneventful recovery post-operation. Pathological results showed that tiny amount of adenocarcinoma tissue was found surrounded by inflammatory cell and fibrous tissue proliferation. No residual tumor cells could be found in the mediastinal lymph nodes, which was considered as the changes after 2 months’ gene therapy. Radiotherapy and targeted treatment had been implemented sequentially