Surgical resection following chemoradiotherapy for thoracic SMARCA4-deficient undifferentiated tumor: a report of two cases.

IF 0.7 Q4 SURGERY
Kensuke Takei, Mitsuhiro Isaka, Junji Wasa, Takuya Kawata, Tatsuya Masuda, Shinya Katsumata, Koki Maeda, Hideaki Kojima, Hayato Konno, Yasuhisa Ohde
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Abstract

Background: Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a high-grade malignant neoplasm with a poor prognosis. Most cases of SMARCA4-UT have extensive chest wall and mediastinum involvement. The efficacy of surgical resection has not been clearly established. Here, we report two surgical cases of SMARCA4-UT with chest wall invasion after chemoradiotherapy.

Case presentation: The first patient was a 40-year-old man with back pain. Computed tomography revealed a 6.8 cm mass in contact with the thoracic vertebrae near the intervertebral foramen, which was suspected to involve the third to fifth ribs. The patient was diagnosed with SMARCA4-UT with clinical T3N0M0 stage IIB. The tumor shrank after chemoradiotherapy, and conversion surgery combined with partial vertebrectomy was performed. Histopathological findings revealed 30% residual tumor in the tumor bed. Thirty-six days after surgery, the patient developed multiple liver metastases and peritoneal dissemination. Chemotherapy combined with immune checkpoint inhibitor treatment was performed, resulting in tumor shrinkage. However, peritoneal dissemination recurred within a short interval. The patient died 5 months postoperatively. The second patient was a 74-year-old man with chest pain. Computed tomography revealed a 7.4-cm mass in the left upper lobe with invasion of the third and fourth ribs. The patient was initially diagnosed with non-small cell lung cancer with clinical T4N1M0 stage IIIA. The tumor shrank after induction chemoradiotherapy, and a left upper lobectomy combined with the chest wall resection was performed. Based on histopathological findings, the patient was diagnosed with SMARCA4-UT. The residual tumor percentage was 3%. The patient was followed up for 12 months postoperatively without recurrence.

Conclusions: We performed the complete resection of SMARCA4-UT following chemoradiotherapy. The two surgical cases had different postoperative courses. Radical surgery after chemoradiotherapy is effective for local control. However, its long-term prognostic efficacy remains unclear. Multidisciplinary approaches and further investigations of novel therapeutic options are required.

胸部 SMARCA4 缺失性未分化肿瘤化疗后手术切除:两例病例报告。
背景:胸部SMARCA4缺陷未分化肿瘤(SMARCA4-UT)是一种预后不良的高级别恶性肿瘤。大多数 SMARCA4-UT 病例广泛累及胸壁和纵隔。手术切除的疗效尚未明确确定。在此,我们报告了两例化放疗后胸壁受侵的 SMARCA4-UT 手术病例:第一例患者是一名 40 岁的男性,背部疼痛。计算机断层扫描发现一个 6.8 厘米的肿块与椎间孔附近的胸椎相接触,疑似累及第三至第五肋骨。患者被诊断为 SMARCA4-UT,临床分期为 T3N0M0 IIB。化放疗后肿瘤缩小,患者接受了转换手术和椎体部分切除术。组织病理学检查结果显示肿瘤床有30%的残余肿瘤。术后36天,患者出现多发性肝转移和腹膜播散。化疗联合免疫检查点抑制剂治疗使肿瘤缩小。然而,腹膜播散在短时间内再次出现。患者术后5个月死亡。第二例患者是一名 74 岁的男性,伴有胸痛。计算机断层扫描显示左上肺叶有一个 7.4 厘米的肿块,并侵犯了第三和第四根肋骨。患者最初被诊断为非小细胞肺癌,临床分期为 T4N1M0 IIIA。诱导化放疗后肿瘤缩小,于是进行了左上肺叶切除术和胸壁切除术。根据组织病理学结果,患者被诊断为 SMARCA4-UT。肿瘤残留率为 3%。患者术后随访12个月,未见复发:我们在放化疗后对 SMARCA4-UT 进行了完全切除。结论:我们在化疗后对 SMARCA4-UT 进行了完全切除,两个手术病例的术后情况不同。化放疗后根治性手术对局部控制有效。然而,其长期预后效果仍不明确。需要采取多学科方法,并进一步研究新的治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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