A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer

Abstract

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.

Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report

“…Although the short-and long-term results of elective salvage surgeries from categories (I) and (II) were considered feasible and acceptable, the outcomes of salvage surgeries from category (III) are less clear. The results of three emergent salvage surgeries in terms of morbidity, mortality, and mean survival duration were 100%, 0%, and 13.5 ± 5 months, respectively, which were considered to be comparable to those of other types of salvage surgeries (categories [I] and [II]) [10]. In the present case, although the first aim of lung resection was palliation, the patient was able to receive chemotherapy again following the emergency lifesaving surgery and achieved survival for over a year.…”

“…However, the long-term feasibility is unknown, because the inoperable patients did not survive in the long term due to poor general health conditions. One study reported that a patient with peripherally located lung cancer who had undergone SBRT developed massive hemoptysis after 4 years and was successfully treated with bronchial artery embolization [10]. Therefore, lateonset adverse events such as massive hemoptysis might be possible, such as in the present case.…”

Clinical application of interventional embolization in tumor-associated hemorrhage

“…During radiotherapy, there is a risk of damaging the blood vessels around the tumors, which easily causes hemorrhage after radiotherapy (26). Clinically, the common ones are hemorrhages after radiotherapy for cervical cancer, bladder cancer, nasopharyngeal cancer and esophageal cancer (27)(28)(29)(30).…”

Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients

“…For instance, different clinical trials have observed rib fractures among patients harboring peripheral tumors in the vicinity of that anatomic structure [30,34]. Kimura et al reported a severe hemoptysis in a patient with a T1bN0M0 lung peripheral cancer receiving 60 Gy (6 fractions), 4.5 years after SBRT [33].…”