Successfully chest irradiation for an advanced squamous cell lung cancer patient with predialysis renal insufficiency.

A mass was detected in a 64-year-old man with haemodialysis independent renal impairment undergoing a routine chest X-Ray (Figure 1). Thirteen years ago, the patient had renal biopsy for the correct diagnosis of nephrotic syndrome, and diagnosed as having IgA nephropathy. He treated the disease with prednisolone for ten years. The patient had cough and dyspnea on effort for three months. He smoked one pack-year for 25 years. Chest computed tomography revealed a mass in the right lung with ipsilateral mediastinal lymphadenopathy. There was small amount of pleural fluid in the right hemithorax, which was evaluated as a malignant pleural fluid clinically (Figure 1). Laboratory testing revealed blood ureanitrogen (BUN) 46.0 mg/dL and creatinine (Cre) 2.86 mg/dL. Histopathological analysis obtained by transbronchial biopsy showed squamous cell cancer (Figure 2). A brain computed tomography, abdominal echogram and bone scintigram revealed nodistant metastasis. Due to his impaired renal function, the patient received thoracic irradiation (2 Gy/day, total 50 Gy). He had no additional chemotherapy. On chest radiograph and CT scan three months after the initiation of chest irradiation, volume loss of the right lung due to post-irradiation change was observed, but no apparent finding of recurrence of squamous cell lung cancer was found (Figure 3). During the follow-up period, the patient developed pneumonia twice and herpes zoster in his left back. At these times, his renal function was tentatively deteriorated with BUN 83.0 mg/dL and Cre 5.35 mg/dlL. Fortunately, however, his renal function unexpectedly returned to the revel with BUN 25.0 mg/ dL and Cre 2.07 mg/dL 15 months after the thoracic Successfully chest irradiation for an advanced squamous cell lung cancer patient with predialysis renal insufficiency doi • 10.5578/tt.24111 Tuberk Toraks 2017;65(3):255-257 Geliş Tarihi/Received: 08.03.2016 • Kabul Ediliş Tarihi/Accepted: 19.06.2016