Case Presentation: Adenocarcinoma of the lung and the role of high dose IGRT PDF Print E-mail
A 78 year old white female presented with a dry, non-productive cough, fatigue and progressive shortnes of breath. Subsequent evaluation demonstrated a large right lung mass that was not visible on a routine chest xray obtained nine months earlier. Needle biopsy confirmed the presence of a moderately-differentiated adenocarcinoma consistent with lung origin. Staging work up, including whole-body PET/CT, was negative for additional sites of disease. The patient was not considered a candidate for surgical resection and chemotherapy was refused. She was then referred for possible radiation therapy for control of progressive symptomatology.

Due to concerns about her borderline oxygen-dependent status, a lung-sparing protocol of image-guided radiotherapy (IGRT) was recommended. An initial 5000 cGy in 250 cGy fractions was delivered; with a two week break to allow for re-simulation to asess response. Target size was reduced after imaging showed a 20% reduction in tumor volume and IGRTcontinued. Final tumor dose was 7500 cGy in 250 cGy fractions. Therapy was tolerated well with minimal fatigue, no increased shortness of breath and no esophagitis.

Follow-up studies 12 weeks post-treatment demonstrated a >90% reduction in tumor volume with no clinical or radiographic evidence of pneumonitis. SUV values were reduced to background levels. The patient shows no recurrence of disease after 2 years, remains active and has discontinued oxygen supplemenation.
 
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