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

Sep 28, 2026

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Anaplastic lymphoma kinase (ALK) gene fusion defines a molecular subtype of non-small cell lung cancer, while axillary lymph node (ALN) metastasis with massive hemorrhage is rare and life-threatening. A 48-year-old man with ALK-positive lung adenocarcinoma and multiple metastases experienced rapid enlargement and rupture of a left ALN causing massive bleeding in February 2024. Interventional and surgical hemostasis were not feasible. Localized radiotherapy (15 Gy/5 fractions, then 39 Gy/13 fractions) achieved rapid bleeding control, partial tumor response, and subsequent healing without recurrent bleeding, but the patient later died from severe mixed infections. Radiotherapy effectively controlled bleeding and provided local tumor control when other treatments failed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background

Case summary

Conclusion

| W | J | C | O | World Journal of
Clinical Oncology | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Oncol 2025 December 24; 16(12): 112140 DOI: 10.5306/wjco.v16.i12.112140 ISSN 2218-4333 (online) CASE REPORT Radiotherapy for large ruptured hemorrhagic axillary lymph node metastasis from anaplastic lymphoma kinase-positive lung adenocarcinoma: A case report and review of literature Zhi-Min Li, Yang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Jun Zhou, Xiao-Na Chang, Quan Chen, Geng Wang, Sheng Zhang, Rui Zhou Specialty type: Oncology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade C Novelty: Grade B Creativity or Innovation: Grade C Scientific Significance: Grade C P-Reviewer: Shi XH, MD, PhD, Associate Chief Physician, China Received: July 21, 2025 Revised: August 20, 2025 Accepted: November 7, 2025 Published online: December 24, 2025 Processing time: 157 Days and 23.3 Hours Zhi-Min Li,, Department of Oncology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan Province, 421001, China Yang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Sheng Zhang, Rui Zhou, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Yang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Sheng Zhang, Rui Zhou, Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Yang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Sheng Zhang, Rui Zhou, Key Laboratory of Precision Radiation Oncology, Wuhan 430022 Hubei Province, China Jun Zhou, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Xiao-Na Chang, Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Quan Chen, Department of Radiology, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Geng Wang, Department of Gastrointestinal Surgery, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China Co-first authors: Zhi-Min Li and Yang-Chenxi Wang. Corresponding author: Rui Zhou, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, [China.](China. mimiruirui2@163.com)[ mimiruirui2@163.com](China. mimiruirui2@163.com) Abstract BACKGROUND Anaplastic lymphoma kinase (ALK) gene fusion is a molecular subtype of nonsmall cell lung cancer, representing 4%-6% of lung adenocarcinomas. Axillary WJCO [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 24, 2025 Volume 16 Issue 12 Li ZM et al. Radiotherapy for ALK-positive lung cancer 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 increas

FAQs

Why is axillary lymph node metastasis with massive bleeding considered unusual in ALK-positive lung adenocarcinoma?

The report states that ALN metastasis from lung cancer is rare, and massive bleeding from such lesions is even more unusual and life-threatening.

What radiotherapy regimen was used to control the ruptured axillary lymph node metastasis?

Localized radiotherapy began at 15 Gray in 5 fractions and was later increased to a total of 39 Gray in 13 fractions.

How did the treatment affect bleeding and local tumor control?

Rapid bleeding control was achieved with a partial tumor response, and the axillary lesion healed without recurrent bleeding.

Sep 28, 2026

Uploaded by Fahsai