Surgical Treatment Options for Stage IV Lung Adenocarcinoma: Risks and Benefits

Q: Surgical Treatment Options for Stage IV Lung Adenocarcinoma: Risks and Benefits

DEAR AKIRA： Stage IV lung cancer is generally inoperable; however, if there is downstaging after targeted therapy, surgery is certainly recommended as it tends to have a higher survival rate. <br>If surgery is not an option, there are many medications available for lung adenocarc

Surgical treatment for stage IV lung adenocarcinoma?

Director Huang, I would like to seek your expertise regarding my mother, who is 68 years old.
In January 2017, a CT scan revealed a 2 cm tumor in the lower right lung.
Follow-up biopsies and Tc-99m MDP scans confirmed stage IV lung adenocarcinoma with metastasis to the ribs and vertebrae.
The biopsy report indicated an EGFR gene mutation.
She has been on Erlotinib (Tarceva) for five weeks.
In early February, a PET scan showed that the bone metastases had disappeared.
The attending physician has recommended surgical resection of the lower one-third of the right lung, followed by additional chemotherapy, although this may lead to potential complications such as shortness of breath while walking.
I would like to inquire about your experience: Is there still a very high risk of recurrence after surgical treatment for stage IV lung adenocarcinoma? If surgery is not pursued, would continuing targeted therapy (considering drug resistance and side effects) be a better option for maintaining the patient's quality of life? Thank you for your time and response, Director Huang.

AKIRA, 40~49 year old female. Ask Date: 2017/02/16

Dr. Huang Yiwen reply Pulmonology

DEAR AKIRA: Stage IV lung cancer is generally inoperable; however, if there is downstaging after targeted therapy, surgery is certainly recommended as it tends to have a higher survival rate.
If surgery is not an option, there are many medications available for lung adenocarcinoma.
Considering your mother's age, she is still a candidate for surgery.
As for not undergoing surgery, individual responses to medication can vary significantly, but it is common to see survival rates of 3 to 5 years.
Changhua Hospital cares about you.

Reply Date: 2017/02/16

More Info

When considering surgical treatment options for Stage IV lung adenocarcinoma, particularly in a patient like your mother, who has a history of EGFR mutation and has shown a positive response to targeted therapy, there are several factors to weigh regarding the risks and benefits of surgery.

Surgical Treatment Considerations
1. Stage IV Lung Adenocarcinoma: This stage indicates that the cancer has spread beyond the lungs to other parts of the body, such as bones in your mother's case. Traditionally, surgery is not a standard treatment for Stage IV lung cancer due to the advanced nature of the disease. However, if there is a significant response to targeted therapy (like the disappearance of bone metastases), surgical intervention may be considered to remove the primary tumor.

2. Potential Benefits of Surgery:
- Improved Survival Rates: Surgical resection of the primary tumor can potentially improve survival rates, especially if the metastases are controlled or have regressed due to effective systemic therapy.

- Symptom Relief: Removing the tumor may alleviate symptoms related to the tumor's presence, such as pain or respiratory issues.

3. Risks of Surgery:
- Postoperative Complications: Surgery can lead to complications such as infection, bleeding, and respiratory issues. In your mother's case, there is a concern about potential long-term effects like shortness of breath or impaired lung function.

- Recurrence: Even after surgery, the risk of cancer recurrence remains high in Stage IV patients. The underlying systemic disease may still progress despite local control of the tumor.

Non-Surgical Treatment Options
1. Targeted Therapy: Continuing with targeted therapy (like Erlotinib or Afatinib) can be a viable option, especially given the patient's age and overall health. Targeted therapies are designed to specifically attack cancer cells with certain genetic mutations (like EGFR), potentially leading to better quality of life and prolonged survival.

2. Quality of Life Considerations:
- Side Effects: While targeted therapies can be effective, they also come with side effects, including skin rashes, diarrhea, and potential development of resistance over time. Monitoring and managing these side effects is crucial for maintaining quality of life.

- Living with Cancer: Many patients with advanced lung cancer live for years with the disease under control through targeted therapies, which may allow them to maintain a better quality of life compared to the potential complications of surgery.

Conclusion
In summary, the decision to proceed with surgery for Stage IV lung adenocarcinoma should be made after careful consideration of the potential benefits and risks. While surgery may offer a chance for improved survival and symptom relief, the high likelihood of recurrence and the risks associated with surgical intervention must be weighed against the benefits of continuing targeted therapy.
Consulting with a multidisciplinary team, including oncologists, thoracic surgeons, and palliative care specialists, can provide a comprehensive view of the best treatment options tailored to your mother's specific situation. Ultimately, the goal should be to balance effective cancer control with maintaining the best possible quality of life.

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