Primary Pulmonary Leiomyosarcoma Successfully Treated With Radiotherapy Followed by Chemotherapy After Recanalization of Central Airway Obstruction by Bronchoscopic Cryotherapy: A Case Report

Primary pulmonary leiomyosarcoma (PPL) is the most common histological subtype of primary pulmonary sarcomas, although it is relatively rare. Herein, we report a case of a 76-year-old man with a mass arising in the hilar region of the right upper lobe of the lung and progressing to the right main bronchus, obstructing the bronchial lumen. He was admitted due to a five-day history of worsening respiratory distress and had a history of left upper lobectomy for primary lung adenocarcinoma. Bronchoscopic cryotherapy enabled the diagnosis of leiomyosarcoma of the lung and was effective in the recanalization of the right main bronchus obstruction caused by the tumor; it also improved his respiratory symptoms and hypoxia. Considering the risk of tumor invasion into the right main bronchus, the patient’s advanced age, and his medical history of left upper lobectomy, surgical resection was deemed extremely difficult. He was treated with radiotherapy for local control followed by doxorubicin and ifosfamide combination chemotherapy, with improvement of chest computed tomography and bronchoscopic findings. Twelve months have passed since the start of radiotherapy for local control, and he has completed the 10th cycle of combination chemotherapy without any signs of tumor recurrence. This case demonstrates that radiotherapy for local control followed by combination chemotherapy with doxorubicin and ifosfamide may improve the prognosis of patients with unresectable PPL.