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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 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is axillary lymph node metastasis with massive bleeding considered unusual in ALK-positive lung adenocarcinoma?","Question",{"text":63,"@type":64},"The report states that ALN metastasis from lung cancer is rare, and massive bleeding from such lesions is even more unusual and life-threatening.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What radiotherapy regimen was used to control the ruptured axillary lymph node metastasis?",{"text":68,"@type":64},"Localized radiotherapy began at 15 Gray in 5 fractions and was later increased to a total of 39 Gray in 13 fractions.",{"name":70,"@type":61,"acceptedAnswer":71},"How did the treatment affect bleeding and local tumor control?",{"text":72,"@type":64},"Rapid bleeding control was achieved with a partial tumor response, and the axillary lesion healed without recurrent 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of\u003Cbr>Clinical Oncology |\n| --- | --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Oncol 2025 December 24; 16(12): 112140  \nDOI: 10.5306/wjco.v16.i12.112140 ISSN 2218-4333 (online)  \nCASE REPORT  \nRadiotherapy for large ruptured hemorrhagic axillary lymph node metastasis from anaplastic lymphoma kinase-positive lung adenocarcinoma: A case report and review of literature  \nZhi-Min Li, Yang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Jun Zhou, Xiao-Na Chang, Quan Chen, Geng Wang, Sheng Zhang, Rui Zhou  \nSpecialty type: Oncology  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade C  \nNovelty: Grade B  \nCreativity or Innovation: Grade C  \nScientific Significance: Grade C  \nP-Reviewer: Shi XH, MD, PhD, Associate Chief Physician, China  \nReceived: July 21, 2025  \nRevised: August 20, 2025  \nAccepted: November 7, 2025  \nPublished online: December 24, 2025  \nProcessing time: 157 Days and 23.3 Hours  \nZhi-Min Li,, Department of Oncology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan Province, 421001, China  \nYang-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  \nYang-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  \nYang-Chenxi Wang, Kai-Yue Wang, Ning-Jing Xie, Sheng Zhang, Rui Zhou, Key Laboratory of Precision Radiation Oncology, Wuhan 430022 Hubei Province, China  \nJun Zhou, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China  \nXiao-Na Chang, Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China  \nQuan Chen, Department of Radiology, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China  \nGeng Wang, Department of Gastrointestinal Surgery, Huazhong University of Science and  \nTechnology, Wuhan 430022, Hubei Province, China Co-first authors: Zhi-Min Li and Yang-Chenxi Wang.  \nCorresponding 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)  \nAbstract  \nBACKGROUND  \nAnaplastic lymphoma kinase (ALK) gene fusion is a molecular subtype of nonsmall cell lung cancer, representing 4%-6% of lung adenocarcinomas. Axillary  \n WJCO  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 24, 2025  Volume 16  Issue 12   \nLi ZM et al. Radiotherapy for ALK-positive lung cancer  \nlymph 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.  \nCASE SUMMARY  \nA 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","cbCaiacO8XsbENPI","https://ap.wps.com/l/cbCaiacO8XsbENPI","pdf",2217995,11,"English","# Abstract\n## Background\n## Case summary\n## Conclusion","[{\"question\":\"Why is axillary lymph node metastasis with massive bleeding considered unusual in ALK-positive lung adenocarcinoma?\",\"answer\":\"The report states that ALN metastasis from lung cancer is rare, and massive bleeding from such lesions is even more unusual and life-threatening.\"},{\"question\":\"What radiotherapy regimen was used to control the ruptured axillary lymph node metastasis?\",\"answer\":\"Localized radiotherapy began at 15 Gray in 5 fractions and was later increased to a total of 39 Gray in 13 fractions.\"},{\"question\":\"How did the treatment affect bleeding and local tumor control?\",\"answer\":\"Rapid bleeding control was achieved with a partial tumor response, and the axillary lesion healed without recurrent bleeding.\"}]","Radiotherapy for large ruptured hemorrhagic axillary lymph node metastasis from anaplastic lymphoma kinase-positive lung adenocarcinoma - A case report and review of literature | PDF",1790564268,28]