The patient, 69 years old, was diagnosed with right central lung cancer by CT and biopsy in an outside hospital for coughing in August, at that time the doctor suggested simultaneous radiotherapy and chemotherapy, but the patient refused.
On August 10, 2013, the right bronchial artery was thickened on bronchial arteriogram, and multiple extravasations of contrast agent were seen in the distal part, suggesting bleeding.
A microspring coil was released after gelatin sponge embolization for further embolization, and no extravasation of contrast agent was seen on re-imaging.
The patient had a pre-existing bronchial dilatation in the left lung, and a left bronchial arteriogram with gelatin sponge embolization was performed.
Postoperatively, the patient’s hemoptysis decreased, but he was still hemoptysis 100-200 ml per day. PET-CT examination was performed and showed a central hypermetabolic necrotic area with a small amount of liquefaction, and the periphery of the tumor was hypermetabolic. Considering the central necrotic liquefaction of the tumor, the tumor was still bleeding from the inner wall.
After the ablation, the patient’s hemoptysis decreased significantly by about 5-10 mL per day. 10 days later, the hemoptysis disappeared completely and the patient had no fever.
On August 19, 2013, after microwave ablation, an enhanced CT examination was performed, and the right lung tumor did not show significant enhancement, and the tumor density was mixed, with pneumatization, and slightly dense hemorrhagic foci and low-density necrotic areas.
The right lung tumor did not show significant enhancement.
Most of the tumor was necrotic, but there seemed to be a little enhancement near the hilum, suggesting that there were still surviving tumors.
The tumor is slightly reinforced medially, and the paraspinal densities are spring circles.
The patient refused chemotherapy and radiotherapy and treated himself with oral troche.
In December 2013, the patient had a small amount of hemoptysis again, and CT examination indicated that the tumor was progressing, and the solid component of the tumor was increasing and intensifying.
The patient was treated with microwave ablation again.
Microwave ablation treatment
Double microwave needle multi-point puncture and ablation treatment.
In January 2014, the patient refused systemic chemotherapy but was willing to undergo interventional chemotherapy. Unfortunately, the bronchial artery had been embolized and no recanalization was seen on imaging, and after discussion with the oncology department, chemotherapy was administered with gemcitabine plus cisplatin via aortic infusion.
On review in February 2014, most of the central tumor was necrotic and there were still surviving tumors in the periphery.
There were still surviving tumors in the periphery of the tumor.
The cranial CT suggested brain metastasis, and whole brain radiotherapy was performed after consultation with radiotherapy department.
Interventional chemotherapy was continued.
In 2014, the right lung tumor progressed and microwave ablation with iodine 125 radioactive particle implantation was performed.
Post-implantation review of iodine 125 particles
Post-implantation review
After microwave ablation of the outer part of the tumor, the tumor was basically necrotic, and the inner part of the lung portal trachea was changed after particle implantation.
Post-microwave ablation and particle implantation review.
The patient was stable after radiotherapy for brain metastases, but developed femoral fracture.
and developed abdominal wall and retroperitoneal metastases.
On review in May 2014, the chest tumor was stable.
The patient was reviewed in May 2014 and the chest tumor was stable.
The chest tumor was stable on review in May 2014.
Excisional biopsy of abdominal wall tumor confirmed lung cancer metastasis and retroperitoneal tumor progression without intervention.
The patient died of systemic failure two months later.
Point of view.
The patient had been found to have lung cancer for 8 months and had refused standardized treatment from Western medicine until he developed hemoptysis before seeking treatment in the emergency room.
Hemoptysis is very common in lung cancer, and most of the results of bronchial artery embolization for hemoptysis in lung cancer are good.
Ablation therapy is rarely used to treat hemoptysis, but our experience suggests that ablation therapy should be considered first for hemorrhage that interventional embolization fails to achieve, and satisfactory results can often be obtained.
In this case, hemoptysis was not only controlled after routine microwave ablation, but also most of the tumor was necrotic, which once again proved that the effect of ablation on hemoptysis deserves our attention.
The patient had central lung cancer with cavity, and ablation treatment had the risk of complicating infection. Fortunately, with anti-infection treatment, the patient had only a short period of heat absorption reaction after the operation, and no obvious infection symptoms occurred.
After ablation treatment, the patient refused chemotherapy. Four months after oral treatment with Troche, a small amount of hemoptysis occurred again and CT suggested tumor progression, microwave ablation treatment was performed again and the patient was advised to receive interventional chemotherapy. Later, the patient was advised to receive interventional chemotherapy. Later, the patient was switched to oral treatment with the Indian version of Eryza. By this time, the patient had already developed brain metastasis and underwent whole brain radiotherapy. After microwave ablation, most of the tumor was necrotic again, suggesting a significant local effect of ablation therapy.
After 4 months, the patient’s tumor progressed again. Considering the risk of ablation of tumor in the hilum, microwave ablation plus iodine 125 radioactive particle implantation was performed, which is a feasible treatment for hilar and mediastinal tumors. Unfortunately, the patient developed multiple metastases and suffered a femur fracture due to trauma, and her body became weaker and weaker, and she died of general failure two months later.
This case suggests that ablation and particle implantation are effective in the treatment of lung cancer locally, but how to combine with systemic treatment to achieve better results still deserves further consideration.