[Complete response by S-1 with multiple pulmonary metastases 4 years after lung resection-a case report]

A male patient in his seventies presented at our hospital with a chief complaint of an abnormal shadow on a chest scout film. We suspected non-small cell carcinoma of the right upper lobe on computed tomography (CT). The patient underwent partial resection of the right upper lobe by video-assisted thoracoscopic surgery in May 2004, frozen sections of which showed poorly differentiated squamous cell carcinoma, consistent with the tumor size 2.5 x 1.7 cm. We performed right upper lobectomy and lymphadenectomy. Final pTNM was T1N0M0, stage IA. The patient had been followed every three months until a coin lesion appeared in the right lower lobe in April 2007. He chose radiation therapy of 48 Gy in total at another hospital with the result that the lesion disappeared. However, the disease recurred in May 2008. Bilateral multiple lung metastases and mediastinal lymph nodes involvement were confirmed by CT. Two courses of docetaxel 60 mg/m(2) (90 mg/body) and cisplatin 80 mg/m / 2 (120 mg/body) were not effective with adverse reaction grade 3. Less docetaxel and cisplatin resulted in a grade 4 reaction. The regimen was changed to S-1 60 mg per day with three weeks on and two weeks off. After two courses complete remission was confirmed at a chest X-ray examination. He has been free of disease with tegafur/uracil 600 mg per day for 4 months.