Oligorecurrent Non-Small-Cell Lung Cancer Treated by Chemo-Radiation Followed by Immunotherapy and Intracranial Radiosurgery: A Case Report and Mini Review of Literature

Locally advanced non-small-cell lung cancer still represents a grey zone in terms of the best treatment choice and optimal clinical outcomes. Indeed, most patients may be suitable to receive different treatments with similar outcomes such as chemo-radiotherapy (CHT-RT) followed by immunotherapy (IO) or surgery followed by adjuvant local/systemic therapies. We report a clinical case of a patient submitted to primary thoracic surgery who developed a mediastinal nodal recurrence successfully treated by CHT-RT-IO. Subsequently, a single brain lesion was found to have been successfully treated by single fraction stereotactic ablative radiotherapy. The patient is still on follow-up and she is free from disease having a good quality of life. In this report, we also perform a mini review about the role of CHT-RT followed by IO in treating loco-regional relapse after surgery. The role of SABR after IO is also evaluated, finding that it is safe and well tolerated. More robust and larger clinical data are needed in this particular setting to better define the role of the combination of systemic and local treatments in the management of intrathoracic and intracranial relapse for patients already submitted to CHT-RT followed by immunotherapy.

Automated summary

Locally advanced non-small-cell lung cancer poses challenges in treatment choice and outcomes. Different treatments such as chemo-radiotherapy followed by immunotherapy or surgery followed by adjuvant therapies may yield similar results. We present a case of successful treatment for mediastinal nodal recurrence after thoracic surgery using sequential chemo-radiotherapy-immunotherapy. The patient also received stereotactic ablative radiotherapy for a single brain lesion. Comprehensive clinical data are needed to determine the role of combining systemic and local treatments in managing relapse after chemo-radiotherapy and immunotherapy.