CRA63 ADVANCE ADENOCARCINOMA LUNG CANCER WITH METASTASES TO BRAIN, ITS NOT THE END OF THE LINE

Azat Azrai Azmel1, Nik NurAtiqah Nik Abeed1 ,Ng Boon Hau1, Marfu’ah Nik Eezamuddeen2, Ramesh Kumar3 , Andrea Ban Yu-Lin1
1Respiratory Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.
2Oncology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.
3Neurosurgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.

Introduction:

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. Brain, bone liver and adrenal are common sites of metastases. Advanced adenocarcinoma presenting with visual disturbance is as initial presentation is a rare. However, given the impact of brain metastases to the quality of life and prognosis, it is important to have well-coordinated local and systemic therapies in managing symptoms and disease control.

We report a 65 years old ex-smoker, diabetic, hypertensive and dyslipidemic patient presented with history of blurring of vision for 5 days. Further history reveal that he was clumsier and bumped into things at home frequently. He presented with visual field defect-Left homonymous hemianopia. Computed tomography of the brain showed a right parieto-occipital intraparenchymal hyperdense mass with white matter oedema, likely involving right optic radiation. Chest radiograph findings of a right hilar mass meant that this likely is a metastasis. Subsequently both brain and lung lesion from CT staging were biopsied and proven to be non-small cell lung cancer favoring adenocarcinoma with evidence of metastasis to brain. Options for immunotherapy was explored and patient was only positive for PDL-1 with 50% expression. Brain lesion underwent tumor excision however subsequent CT brain showed suspicion of new lesion in the brain which was confirmed by MRI Brain. Second surgery was done 1 month apart for tumour excision which showed complete removal of the largest lesion. Small lesions were targeted via Gamma Knife in a total of two sessions which showed good resolution of the lesions.

Conclusion

Multidisciplinary collaboration at early stage will aid in prompt diagnosis and hence broaden the treatment options even in advance stages of adenocarcinoma of the lung. There is a role for Gamma Knife in brain metastases in advance lung adenocarcinoma with concomitant chemo/immunotherapy.