Abstract
Reports of treatment methods during surgery for the lungs with radiation pneumonitis have been rare. The case was a 65-year-old male patient who was diagnosed with stage IV thymic cancer based on the Masaoka classification. He underwent 4 courses of CDDP+ETP and gamma knife treatment for cerebral metastasis. After a decrease in the size of the primary lesion and disappearance of the cerebral metastasis were confirmed, surgery was performed to remove the remaining tumor together with the thymus gland and to partially excise the parietal pleura together with the left upper lobe. During the surgery, an aerial fistula was confirmed in the region of radiation pneumonitis and was closed with stitches. On postoperative day 90, when a left thoracostomy tube was inserted to examine the decrease in left pleural fluid, an aerial fistula was confirmed. During surgery on postoperative day 120, a fistula was observed in the region of radiation pneumonitis, and was covered with intercostal muscle. Although the patient survived for 3 years after the surgery, 2 episodes involving a decrease in left pleural fluid, fever, and a sensation of dyspnea were confirmed during the follow-up observation, suggesting that the fistula had not closed. In the region of radiation pneumonitis, wound healing and immunity are markedly reduced due to a decrease in blood flow. Therefore, a pulmonary fistula in the region of radiation pneumonitis requires careful repair, and it is recommended that such a fistula be covered with either a muscle flap or pericardial adipose tissue.
