Case of a Long-Time Survivor with Recurrent Multiple Brain Metastases from Lung Cancer: Terminal Stage Cancer or Chronic Disease

Metastasectomy and Stereotactic Body Radiotherapy for Colorectal Cancer With Liver and Lung Oligometastases: A Case Report of Complete Remission in a 96-Year-Old Patient

We report a rare case of an extremely old colorectal cancer (CRC) patient who had complete remission after liver metastasectomy and stereotactic body radiotherapy (SBRT) to lung oligometastases (OM), with good quality of life and no evidence of recurrence 12 years after the initial diagnosis. An 83-year-old male patient had a right hemicolectomy for stage pT3 pN0 adenocarcinoma of the colon. Soon he was found to have liver metastasis treated with radiofrequency ablation and then liver metastasectomy with clear margins, followed by chemotherapy in the form of FOLFIRI for six months. Six years later, positron emission tomography (PET) showed 1.6 cm OM in the left upper lobe lung. He was not considered a good candidate for surgery. We offered him SBRT 48 Gy in four fractions every other day. The lesion disappeared with no recurrence in the same location on PET and serial computed tomography (CT) scans. Three years later, PET-CT found a new OM in the left lingular lung measuring 1.2 cm. A CT-guided lung biopsy confirmed invasive adenocarcinoma favoring OM from the CRC. SBRT planning failed due to its proximity to the heart. He accepted the longer course of conventional volumetric modulated arc therapy at 60 Gy in 15 fractions with daily cone-beam CT guidance. Again, he tolerated treatment very well with no significant side effects, despite his age. He did not require any chemotherapy or other systemic treatment in the last 11 years, so he did not experience any toxicities related to such treatment. This case is important to show that old age alone should not be considered a contraindication for metastasectomy and SBRT for CRC with liver and lung OM.

Case of Complete Remission from Palliative Radiation in Extensive Stage Small Cell Lung Cancer With Large Brain Metastasis Nine Years After Diagnosis: Cure Is Possible

Extensive stage small cell lung cancer (ES-SCLC) with symptomatic brain metastasis (BM) carries very poor prognosis with a median survival of only three to four months. This case shows the potential benefit of offering aggressive multimodality treatment to achieve the best quality of life and to improve survival. A complete response (CR) was achieved following craniotomy, whole brain irradiation (WBI), palliative chemotherapy, and palliative consolidative thoracic radiotherapy (CTRT) for ES-SCLC with large symptomatic BM. There was no residual cancer or further metastasis seen on CT imaging. The patient remains cancer free and asymptomatic nine years after the initial diagnosis.