Long-term survival of a patient with stage IV pulmonary large cell carcinoma achieved by combined-modality therapy: Report of a case

We describe herein the case of a 59-year-old-man with stage IV pulmonary la rge cell carcinoma and a giant brain metastasis, in whom two sublines with different growth characteristics and drug sensitivities in vitro were estab lished from the primary tumor. Disease-free survival for more than 5 years after surgery was achieved by combined-modality therapy together with surge ry to remove the primary tumor, radiation to the brain metastasis, and chem otherapy to presumed hematogenous dissemination. Subline 1 proliferated in a monolayer of epithelial-like cells, while subline 2 showed a floating col ony pattern of proliferation, resembling the typical growth characteristics of small cell lung cancer (SCLC) cells in vitro, Subline 2 was sensitive t o a number of drugs, namely, vincristine (VCR), cyclophosphamide (CPM), adr iamycin (ADR), and cisplatin (CDDP), whereas subline 1 was resistant to man y drugs, The patient was treated with a combination of 44 Gy of whole-brain irradiation and a number of cycles of chemotherapy comprised of ADR, VCR, and CPM, followed by CDDP, VCR, and CPM, based on the results of sensitivit y testing of the subline 2 cells. As a result, the patient has been disease -free for more than 5 years postoperatively, In conclusion, this case repor t serves to demonstrate that meticulous combined-modality treatment taking tumor heterogeneity in human cancers into account may be necessary to achie ve breakthroughs in current cancer therapy for advanced lung cancer.