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J Med Case Rep. 2017 Dec 10;11(1):343. doi: 10.1186/s13256-017-1504-z.

Serious gastric perforation after second stereotactic body radiotherapy for peripheral lung cancer that recurred after initial stereotactic body radiotherapy: a case report.

Author information

1
Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan. hnonaka@yamanashi.ac.jp.
2
Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan.
3
Department of Radiation Oncology, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu Ward, Shizuoka City, Shizuoka, 424-8636, Japan.
4
Department of Radiology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi Ward, Shizuoka City, Shizuoka, 420-8527, Japan.

Abstract

BACKGROUND:

In recent reports, re-irradiation with stereotactic body radiotherapy for lung tumors in patients previously treated with thoracic radiation therapy resulted in several serious toxicities. Serious non-lung toxicities were observed mostly in patients with central tumors, but we experienced a case of fatal gastric perforation after a second stereotactic body radiotherapy in a patient with a peripheral lung tumor.

CASE PRESENTATION:

An 83-year-old Asian man was diagnosed with T2N0M0 lung cancer in the form of squamous cell carcinoma in the lower lobe of his left lung. He was treated with stereotactic body radiotherapy of 40 Gy in 4 fractions and the tumor decreased in size in partial response. The local tumor recurred 8 months after the first stereotactic body radiotherapy, and he was re-irradiated with a second stereotactic body radiotherapy of 50 Gy in 4 fractions. A Sengstaken-Blakemore tube was inserted below his diaphragm by laparoscopic surgery before the second stereotactic body radiotherapy in order to reduce the stomach dose by keeping his stomach apart from the tumor. Two months after the second stereotactic body radiotherapy, he developed fatal gastric perforation and gastropleural fistula penetrating his diaphragm.

CONCLUSIONS:

To the best of our knowledge, this is the first report about a gastric perforation after stereotactic body radiotherapy for lung tumors and it warns of serious complication of stereotactic body radiotherapy in not only centrally located but also peripherally located tumors like in this case.

KEYWORDS:

Gastric perforation; Lung cancer; Re-irradiation; Stereotactic body radiotherapy

PMID:
29223168
PMCID:
PMC5723405
DOI:
10.1186/s13256-017-1504-z
[Indexed for MEDLINE]
Free PMC Article

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