The patient was a 66-year-old male who presented to the clinic with cough, poor appetite, fatigue and wasting.
The chest X-ray suspected lung cancer and further CT examination was performed.
CT cross-sectional view
CT coronal view
CT report: central lung cancer with mediastinal hilar lymph node metastasis in the right lung.
Bronchofiberscopy for pathology: hypofractionated squamous carcinoma.
The patient had financial difficulties and poor general condition, PET-CT was not performed and genetic testing was not performed.
No other tumors were detected by head MRI, whole abdomen ultrasound and bone scan.
The patient’s general condition was poor, wasted and fatigued, and the oncology department refused chemotherapy and radiotherapy. Chinese medicine and supportive treatment were recommended.
Later, the patient was introduced by a friend to our department for treatment.
At that time, the patient’s general condition was poor, he needed help to walk, coughing and poor nausea. After one week of supportive treatment, the patient’s strength improved slightly, and he tried bronchial artery perfusion chemotherapy after repeated explanation of his condition.
On October 10, 2014, the first bronchial artery infusion chemotherapy was administered. A small dose of gemcitabine plus cisplatin was used for slow perfusion, and a microcatheter was not used to save costs.
Three weeks later, the patient showed slight improvement and underwent a second interventional chemotherapy.
On December 10, 2014, the CT was repeated and the tumor had shrunk compared to the previous one, which revealed a central right upper lung lung cancer with right upper lung atelectasis and a slight shift of the mediastinum to the right.
Right lung tumor with pulmonary dysplasia
The tumor was visible 1 cm above the upper part of the pulmonary artery.
Mediastinal lymph node metastatic tumor can be seen
The level of the superior border of the right pulmonary artery. The tumor is largely absent at this level.
The blood supply to the tumor artery has been reduced compared to the previous interventional chemotherapy.
After 4 weeks, systemic chemotherapy was changed to save medical cost.
After two systemic chemotherapy sessions, he was rechecked.
The tumor was basically stable. The right central lung cancer with pulmonary atelectasis and tumor invasion of the hilum and mediastinum can be seen.
The tumor was basically stable. Central lung cancer of the right lung with pulmonary dysplasia and tumor invasion of the hilum and mediastinum can be seen.
The tumor is basically stable. A central type of lung cancer with pulmonary dysplasia in the right lung and tumor invasion of the hilum and mediastinum can be seen.
The tumor is basically stable. A central type of lung cancer with pulmonary dysplasia in the right lung and tumor invasion of the hilum and mediastinum can be seen.
The tumor is basically stable. Central lung cancer with pulmonary dysplasia in the right lung and tumor invasion of the hilum and mediastinum can be seen.
The patient’s physical condition further improved. Iodine 125 radioactive particle implantation was performed.
Iodine 125 particle implantation was performed on March 2, 2015.
Particle implantation was performed.
Systemic chemotherapy was continued after particle implantation, and the tumor was stable on review two months after particle implantation.
Postoperative review, tumor stable.
October 2014 CT localization image.
August 10, 2015 CT localization image 5 months after particle implantation. The tumor is significantly smaller than before.
Point of view.
The patient’s general condition was poor at the initial visit and could not tolerate systemic chemotherapy, so we gave a small dose of transbronchial artery infusion chemotherapy.
The role of transbronchial artery infusion chemotherapy is now gradually being denied by oncologists, but my current opinion is that interventional chemotherapy may have better results than systemic chemotherapy when tried for central lung cancer at first, so it still has some value. Fortunately, this patient was one of the patients with better results. After three interventional chemotherapy sessions, the tumor shrank and the patient’s physical condition gradually improved, and we later switched to systemic chemotherapy with gemcitabine plus cisplatin.
In order to reduce complications such as pneumothorax and bleeding, we referred to the dose of the TPS planning system, but did not follow the TPS puncture and release method. In this case, we only punctured two needles in total and released the particles intensively, aiming at complete coverage of the tumor with the particle release radiation. The patient did not have pneumothorax or hemoptysis, and was discharged on the third day after the surgery. The patient’s general condition was good, and he did not feel any discomfort.
At present, the patient is doing well, but for financial reasons, he has not been able to consider targeted therapy and continues to be followed up closely.