Radiotherapy for large ruptured hemorrhagic axillary lymph node metastasis from anaplastic lymphoma kinase-positive lung adenocarcinoma: A case report and review of literature.

[BACKGROUND] Anaplastic lymphoma kinase () gene fusion is a molecular subtype of non-small cell lung cancer, representing 4%-6% of lung adenocarcinomas. Axillary lymph node (ALN) metastasis from lung cancer is rare, and massive bleeding from such lesions is an even more unusual and life-threatening complication. This case demonstrates how localized radiotherapy can be used as an effective hemostatic and tumor-controlling measure when conventional interventions fail.

[CASE SUMMARY] A 48-year-old male presented in October 2019 with ALK-positive lung adenocarcinoma and multiple metastases. He received multiple lines of ALK tyrosine kinase inhibitor therapy, whole-brain radiotherapy, stereotactic radiotherapy, chemotherapy, and targeted agents over 4 years and 7 months. In February 2024, rapid enlargement and rupture of a left ALN metastasis caused massive bleeding. Interventional and surgical hemostasis were not feasible. Localized radiotherapy was initiated at 15 Gray in 5 fractions, later increased to a total of 39 Gray in 13 fractions, resulting in rapid bleeding control and partial tumor response. The patient subsequently received chemotherapy, and the axillary lesion healed without recurrent bleeding. However, three months later, he developed severe pneumonia with mixed bacterial, mycobacterial, and fungal infections and died despite intensive care.

[CONCLUSION] Radiotherapy can effectively control bleeding and achieve local tumor control in ALK-positive lung cancer with ruptured ALN metastasis when other treatments are ineffective.