Sustained complete remission in chemotherapy-refractory advanced lung adenocarcinoma with bevacizumab and iodine-125 seed implantation: A long-term case report.

[RATIONALE] The introduction of small-molecule tyrosine kinase inhibitors and immune checkpoint inhibitors has transformed therapeutic strategies for lung adenocarcinoma, significantly improving the survival of eligible patients. However, the prognosis remains poor for those lacking actionable driver mutations and presenting with brain metastases, who typically exhibit a median survival of <6 months.

[PATIENT CONCERNS] After the initial resection (November 2016) and progression after adjuvant paclitaxel/cisplatin chemotherapy, the patient developed brain and pulmonary metastases.

[DIAGNOSES] Lung adenocarcinoma (cT3N0M1c, AJCC 8th edition) with synchronous brain and pulmonary metastases molecularly characterized as epidermal growth factor receptor- and anaplastic lymphoma kinase-negative.

[INTERVENTIONS] Complete remission was attained through a combined approach: whole-brain radiotherapy (WBRT) for intracranial lesions, CT-guided iodine-125 (125I) seed implantation for lung metastases, and maintenance bevacizumab (BEV).

[OUTCOMES] At the latest follow-up, the patient maintained complete remission for over 92 months, with a Karnofsky performance status of 100, demonstrating unprecedented long-term survival.

[LESSONS] This case demonstrates the potential synergistic efficacy of whole-brain radiotherapy, 125I brachytherapy, and antiangiogenic therapy in advanced epidermal growth factor receptor/anaplastic lymphoma kinase wild-type lung adenocarcinoma, providing a novel salvage strategy for chemotherapy-refractory metastatic disease. Prospective clinical trials are warranted to validate the survival benefits of this multimodal approach in molecularly unselected, high-risk populations.