[Epidermal Growth Factor Receptor-mutated Advanced Lung Adenocarcinoma with Long-term Tumor-free Survival by Chemotherapy Followed by Tyrosine Kinase Inhibitor Treatment after Reduction Surgery].

A 67-year-old woman was detected stage III B adenocarcinoma of the left lung, with epidermal growth factor receptor(EGFR) -mutation. Since chest computed tomography showed enlarged lymph nodes in stations 7 and 1R-4R, radiochemotherapy was recommended. However, she declined radiochemotherapy and the chemotherapy after tumor reduction surgery was chosen. She underwent resection of the left lower lobe and lingular segment, and mediastinal lymph node dissection through a posterolateral thoracotomy by extended bronchoplasty(type C) due to the extranodal invasion of lymph nodes to the lingular segmental bronchus. At postoperative day 21, she underwent right superior mediastinal lymph node dissection through a median sternotomy. Postoperatively, she received 6 cycles of chemotherapy with carboplatin plus paclitaxel followed by gefitinib. 1.5 years later, gamma knife surgery was done for multiple cerebral metastases, followed by 4 cycles of chemotherapy with cisplatin plus pemetrexed and then erlotinib. Six years after surgery, she is surviving without any evidence of disease recurrence. Tumor reduction surgery, when followed by chemotherapy, for EGFR-mutant lung adenocarcinoma is likely to lead to long-term survival.