Fatal Broncho-Mediastinal Fistula in a Patient with Non-Small Cell Lung Cancer after Photodynamic Therapy

ABSTRACT

Photodynamic therapy (PDT) can be used as palliative therapy to reduce obstructive symptoms in patients with advanced lung cancer. Herein, we report on the case of a patient with fatal broncho-mediastinal fistula after PDT. A 57-year-old woman was diagnosed as non-small cell lung cancer (squamous cell carcinoma, cT4N3). She received PDT on the endobronchial mass obstructing her right main bronchus twice in 48 hours interval. Two weeks later, concurrent chemoradiation therapy (CCRT) with weekly Paclitaxel/Carboplatin was started. During maintenance chemotherapy, a new nodule in her scalp developed and turned out to be a metastatic nodule. A broncho-mediastinal fistula was suspicious on follow-up chest computed tomography and a broncoscopy revealed an extensively damaged medial right main bronchial wall. On the day following bronchoscopy, the patient died of sudden massive hemoptysis.