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Vol.53 No.4 contents | Japanese/English |
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- Case Report -
Development of Pyopneumothorax During Bevacizumab-containing Chemotherapy in a Patient with Lung Adenocarcinoma
Tomoya Kono1, Ryo Miyata1, Junpei Takagi2, Takashi Hanatani2, Yasutaka Takubo1, Tetsuo Noguchi21Division of Thoracic Surgery, 2Division of Respiratory Disease, Nagahama City Hospital, Japan
Background. Bevacizumab-containing chemotherapy is widely used in current lung cancer treatment. Case. A 63-year-old male was admitted to the hospital with chief complaints of a cough and weight loss. Chest computed tomography (CT) showed a tumor (50 mm in diameter) in the lower lobe of the right lung. A bronchoscopic biopsy revealed adenocarcinoma of the lungs. A whole-body examination demonstrated metastasis to the liver and pelvis; therefore, a diagnosis of stage IV adenocarcinoma (cT2bN3M1b) was made. Chemotherapy with carboplatin, paclitaxel and bevacizumab was initiated; however, a right pyopneumothorax developed on day 15 of the regimen. Although we promptly performed continuous chest drainage, the patient's condition did not improve. A chest CT scan showed that the pyopneumothorax had occurred due to the rupture of the tumor. Hence, we performed right lower lobectomy along with thoracotomy. After the surgery, a bronchial stump fistula developed, and omentoplasty was subsequently performed. We continued with the same chemotherapy regimen; however, the patient developed carcinomatous meningitis and died one year after the first medical examination. Conclusions. The use of bevacizumab-containing chemotherapy may lead to pneumothorax or pyothorax because bevacizumab causes extensive tumor necrosis. Intractable pneumothorax or pyothorax should be diagnosed using CT. If necessary, surgery should thus be performed as soon as possible.
key words: Lung cancer, Chemotherapy, Pyopneumothorax, Bevacizumab, Salvage operation
Received: October 18, 2012
Accepted: July 22, 2013
JJLC 53 (4): 336-340, 2013
