Spontaneous regression of locally advanced lung cancer: a ca
Published in the journal Medicine, the authors report a case of a patient diagnosed with locally advanced non-small cell lung cancer.

A 77-year-old man initially presented with intermittent right upper chest pain of a month's duration. This was reported as being mild and not requiring analgesia. He had no significant past medical history and had a good performance status. He was a lifelong nonsmoker, and denied experiencing other associated symptoms like cough, dyspnoea, haemoptysis, anorexia, loss of weight, headache, or dizziness.

A chest x-ray revealed a right middle zone lesion, and a subsequent computed tomography (CT) scan of the thorax and liver revealed a 5.8 × 5.0 cm mass in the anterior segment of the upper lobe of the right lung, abutting the transverse fissure and infiltrating the lateral chest wall with erosion of the third rib.

There was also a 2.0 × 1.7 cm enlarged right hilar node. He underwent a bronchoscopy with endobronchial ultrasound and transbronchial biopsies. A tumor was seen arising from the anterior segment of the right upper lobe. Histopathological examination confirmed the diagnosis of a poorly differentiated NSCLC with marked nuclear pleomorphism, with no targetable mutations found on further testing.

As there was no evidence of metastatic disease on bone scan or CT brain, he was staged as having T3N1M0 (Stage IIIA) disease. Radical (curative) intent radiation therapy with concurrent chemotherapy was recommended, but the patient declined. Palliative radiation therapy was also discussed and declined by the patient. He instead opted to alter his diet, increasing his intake of fruit and vegetables, and take up exercise.

Upon review at about 3 months after his diagnosis, he reported resolution of his chest pain. A CT scan repeated then showed a significant reduction in the size of the right upper lobe mass, now measuring 3.8 × 2.7 cm but still invading the right anterior chest wall with associated erosion of the third rib. The right hilar node also demonstrated reduction in size now measuring 2.2 × 1.4 cm.

Serial scans done at 6, 9, 12, and 18 months after initial diagnosis continued to reveal further decrease in size of the lesions. The most recent CT scan of the thorax and liver, done 24 months after diagnosis, shows a stable focus of soft tissue density at the site of the primary tumor, with associated scarring of the adjacent lung parenchyma and tethering of the adjacent pleura and sclerotic changes at the right anterior third rib. There are no enlarged right hilar lymph nodes, and no other lymphadenopathy or metastases.

Lessons learnt:-
- Spontaneous regression of non-small cell lung cancer, by virtue of its scarcity, has not been well-studied and is poorly understood.

-Further studies are required, in order to clarify the mechanisms by which spontaneous regression occurs, and possibly identify new targets for cancer treatment.

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