A Case of Bulky Chest Wall Metastasis of Lung Cancer Occurred as Cystic Lesion, Completely Cured by Radiotherapy

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Background. Lung cancer patients with skin metastasis often have other metastatic lesions and poor prognosis. To treat skin metastasis, chemotherapy is not effective and radiotherapy or surgical resection is usually performed as palliative therapy. Case. A 61-year-old woman who had undergone right middle and lower lobectomy for pulmonary adenocarcinoma developed subcutaneous swelling on the right side of her back 3 months later. Chest CT showed a 10-cm cystic lesion in size with a thin wall. Since the cyst did not decrease, resection was performed 3 months later. However, the drainage tube could not be removed due to effusion. Two months later, a second resection of the cyst was performed and a metastatic tumor was recognized. Effusion did not decrease and poor control of the drainage caused pain. Therefore the cystic metastatic lesion was opened with a 15 cm skin incision. The opened metastatic lesion continued to grow and became infected with MRSA. Radiotherapy of 30 Gy was performed in spite of the open wound. Four months after the radiotherapy, the necrotic tumor was completely removed and she was discharged. By 8 months after the radiotherapy, the opened wound was covered by the epithelium, and the metastatic tumor disappeared. Conclusion. Radiotherapy cured the bulky chest wall metastasis with an open lesion under careful general and local treatment.