A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer
A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer
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DOI：
10.1007/s11604-015-0423-4
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发表时间：
2015-06-01
影响因子：
2.1
通讯作者：
Kodaira, Takeshi
中科院分区：
文献类型：
--
作者：
Kimura, Kana;Tomita, Natsuo;Kodaira, Takeshi
在立体定向体部放疗（SBRT）治疗中心型非小细胞肺癌（NSCLC）中，有几项研究报告了严重咯血。我们在此报告一个罕见的病例，虽然肺部肿瘤位于周围，但在SBRT后仍有咯血。一位79岁男性的肺部结节意外发现在左上叶的外围。在电脑断层引导下对这个结节进行活检，证实了低分化腺癌的诊断。临床诊断为T1bN0M0，I期原发性肺癌。患者接受SBRT治疗，使用螺旋断层放射治疗，剂量为60戈伊，分6次（即，床10 = 120）。他获得了完全缓解，没有复发。然而，患者在SBRT后4.5年出现大咯血。由于根据支气管动脉造影的SBRT视野，在左肺观察到左支气管动脉血供过多，因此进行了支气管动脉栓塞（BAE）手术。患者在BAE后未发生咯血。虽然SBRT治疗早期NSCLC通常是安全有效的，但在SBRT中必须小心晚发性支气管出血，即使是外周肿瘤。
In stereotactic body radiotherapy (SBRT) for centrally located non-small cell lung carcinoma (NSCLC), severe hemoptysis has been reported in several studies. We report here a rare case of hemoptysis after SBRT even though the lung tumor was peripherally located. A lung nodule of a 79-year-old man was accidentally found at the periphery of the left upper lobe. A computed tomography-guided biopsy of this nodule provided confirmation of the diagnosis of poorly differentiated adenocarcinoma. The clinical diagnosis was T1bN0M0, stage I primary lung cancer. The patient was treated with SBRT using helical tomotherapy at a dose of 60 Gy in 6 fractions (i.e., BED10 = 120). He obtained a complete response and did not experience recurrence. However, the patient suffered massive hemoptysis 4.5 years after SBRT. As hypervascularity of a left bronchial artery was observed at the left lung in accordance with SBRT field on bronchial arteriography, a bronchial artery embolization (BAE) procedure was performed. The patient has had no episodes of hemoptysis after BAE. Although SBRT for early stage NSCLC is usually safe and efficient, it is necessary to be careful for late-onset bronchial hemorrhage in SBRT, even for a peripheral tumor.