What happened, in summary

An older man was treated for a slowly enlarging right upper-lobe lung nodule that had first appeared 5 years earlier on a CT scan done for a prolonged cough. The nodule began as a 1 cm mixed ground-glass lesion with a 3 mm solid component and gradually grew to 1.5 cm with a 5 mm solid component. Whole-body CT showed no lymph-node or distant metastases. Although bronchoscopy was recommended, he declined the invasive procedure. After tumor board review, the lesion was managed as clinically suspected well-differentiated lung adenocarcinoma, staged cT1miN0M0 Stage IA1.

His treatment plan required extra care because he had long experienced nausea and discomfort when lying flat or on his left side. During the radiation-planning 4D-CT scan, he developed sudden sweating, nausea, and vomiting that improved once he sat up. Additional imaging suggested possible idiopathic inferior vena cava compression related to his anatomy rather than a tumor. To avoid triggering those symptoms, his stereotactic body radiation therapy was delivered in the prone position with a right lateral tilt.

The lung lesion was treated with 56 Gy in 4 fractions using free-breathing volume-modulated arc therapy. He tolerated treatment without recurrence of the positional symptoms. Follow-up chest imaging showed grade 1 radiation pneumonitis, peaking about 6 months after SBRT, without complications. At 1 year, CT showed radiation fibrosis and complete metabolic response, with no enlarging mass suggesting local recurrence. He remained under follow-up while avoiding prolonged supine or left-sided positioning and maintaining hydration and appetite to reduce future hypotension episodes.