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

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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.

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  1. Tomita N, Kodaira T, Teshima T, Ogawa K, Kumazaki Y, Yamauchi C, et al. Japanese structure survey of high-precision radiotherapy in 2012 based on institutional questionnaire about the patterns of care. Jpn J Clin Oncol. 2014;44:579–86.

    Article  PubMed  Google Scholar 

  2. Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams M, Henderson MA, et al. Stereotactic body radiation therapy for early stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys. 2009;75:677–82.

    Article  PubMed  Google Scholar 

  3. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early stage lung cancer. J Clin Oncol. 2006;24:4833–9.

    Article  PubMed  Google Scholar 

  4. Onishi H, Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies. Jpn J Clin Oncol. 2013;43:345–50.

    Article  PubMed  Google Scholar 

  5. Song SY, Choi W, Shin SS, Lee SW, Ahn SD, Kim JH, et al. Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus. Lung Cancer. 2009;66:89–93.

    Article  PubMed  Google Scholar 

  6. Tomita N, Kodaira T, Matsuo M, Furutani K, Tachibana H, Daimon T, et al. Helical tomotherapy for solitary lung tumor: feasibility study and dosimetric evaluation of treatment plans. Technol Cancer Res Treat. 2010;9:407–15.

    Article  PubMed  Google Scholar 

  7. Chi A, Liao Z, Nguyen NP, Xu J, Welsh JS, Jang SY, et al. Dosimetric selection for helical tomotherapy based stereotactic ablative radiotherapy for early stage non-small cell lung cancer or lung metastases. PLoS One. 2012;7:e35809.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. JROSG10-1. Accessed 10 Feb 2015.

  9. Nagai A, Shibamoto Y, Yoshida M, Inoda K, Kikuchi Y. Safety and efficacy of intensity-modulated stereotactic body radiotherapy using helical tomotherapy for lung cancer and lung metastasis. BioMed Res Int. 2014;2014:473173.

    PubMed Central  PubMed  Google Scholar 

  10. Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovasc Intervent Radiol. 2010;33:240–50.

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Kana Kimura.

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Kimura, K., Tomita, N., Shimizu, A. et al. A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer. Jpn J Radiol 33, 370–374 (2015).

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