EGFR-mutated non-small cell lung cancer with mediastinal invasion is generally considered unresectable, yet some patients may benefit from surgery combined with targeted therapy. We report a 60-year-old female with stage IIIB (T4N2) disease involving the trachea and SVC. After two cycles of neoadjuvant cisplatin-vinorelbine, restaging showed tumour regression. Using 3D modeling, she underwent a right upper double-sleeve bilobectomy with tracheal bifurcation sleeve resection and SVC replacement with a xenopericardial conduit. Histopathology confirmed negative margins but no major pathological response, with multistation N2 involvement. Postoperative molecular testing revealed EGFR exon 19 deletion, and adjuvant osimertinib was initiated. She remained recurrence-free for 35 months. At 35 months, new mediastinal and pleural lesions appeared; biopsy identified the original EGFR deletion plus MET, CDK4, and MDM2 amplifications and CDKN2A loss. Crizotinib induced a transient radiographic response, but she developed progressive cachexia and died at 42 months. This case underscores the feasibility of complex surgery and the critical need for molecular monitoring and rebiopsy at progression. Advanced 3D modeling was instrumental in safe planning and execution.
The work titled “Surgery for Locally Advanced Stage IIIB (T4N2) EGFR-Mutated Lung Adenocarcinoma in the Era of Targeted Therapy: A Case Report”, was published on Malignancy Spectrum (published on June 30, 2026).
DOI：10.15302/MSP.2026.0014