Kimura Kana, Tomita Natsuo, Shimizu Arisa, Sato Yozo, Makita Chiyoko, Kodaira Takeshi
Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusaku, Nagoya, 464-8681, Japan,
Jpn J Radiol. 2015 Jun;33(6):370-4. doi: 10.1007/s11604-015-0423-4. Epub 2015 Apr 22.
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.
在针对中心型非小细胞肺癌（NSCLC）的立体定向体部放射治疗（SBRT）中，多项研究报告了严重咯血的情况。我们在此报告一例罕见的SBRT后咯血病例，尽管肺部肿瘤位于外周。一名79岁男性的肺结节在左上叶外周意外发现。对该结节进行计算机断层扫描引导下活检，确诊为低分化腺癌。临床诊断为T1bN0M0，I期原发性肺癌。患者接受螺旋断层放疗进行SBRT治疗，剂量为60 Gy，分6次给予（即BED10 = 120）。他获得了完全缓解且未复发。然而，患者在SBRT后4.5年出现大量咯血。根据支气管动脉造影上与SBRT照射野一致的情况，观察到左肺左支气管动脉血管增多，遂进行了支气管动脉栓塞（BAE）手术。患者在BAE术后未再发生咯血。尽管早期NSCLC的SBRT通常安全有效，但即使对于外周肿瘤，在SBRT中也有必要注意迟发性支气管出血。
