Complete pathological response in T4 non-small cell lung cancer with chest wall involvement

Introduction: This is a case of locally advanced lung carcinoma with a complete pathological response to neoadjuvant chemoimmunotherapy. Case report: A 56-year-old male, smoker, presented to the emergency department with left-sided chest wall pain lasting three months, without respiratory symptoms or systemic signs. Chest CT revealed a large apical mass in the left upper lobe with central necrosis, contact with parietal and mediastinal pleura, and erosion of the second rib. PET-CT confirmed chest wall invasion and a mildly hypermetabolic lymph node. Lung biopsy showed poorly differentiated non-small cell carcinoma, PD-L1 positive in 70% of tumor cells. Staging with endobronchial ultrasound and mediastinoscopy ruled out mediastinal lymph node involvement. Clinical staging was cT4N0M0, stage IIIA, and neoadjuvant treatment with cisplatin, vinorelbine, and nivolumab was initiated, with good tolerance. Follow-up imaging showed a partial response, with reduction in tumor size and metabolic activity (cyT3N0M0), leading to left upper lobectomy and resection of the first three ribs. Pathological analysis revealed a complete response (ypT0ypN0), with no viable tumor, no lymphovascular invasion, and negative margins. Conclusion: The patient is currently under postoperative follow-up and awaiting the first control CT scan. This case highlights an excellent outcome with neoadjuvant chemoimmunotherapy in a patient with locally advanced non-small cell lung cancer.