The 61-year-old patient from Kazakhstan has endured a long and difficult journey in his fight against cancer ever since a pulmonary nodule was first detected in 2018. At that time, a routine health examination revealed a ground-glass nodule in the upper lobe of his right lung. The local recommendation was limited to regular follow-up without any medical intervention, allowing the lesion to progress silently over the following years. It was not until a follow-up CT scan in December 2024 that the once tiny nodule had enlarged into a 6.5 × 4.9 × 3.5 cm solid mass. In January 2025, pathological examination confirmed moderately differentiated bronchial adenocarcinoma of the right upper lobe. Genetic testing identified an EGFR G719X mutation, and the disease was clinically staged as Stage IIIA, with mediastinal lymph node metastasis.

1. Complete Pneumonectomy Performed as the Initial Treatment, Leaving Irreversible Lifelong Consequences

Following the diagnosis, the patient underwent right total pneumonectomy combined with lymph node dissectionat a local hospital on February 14, 2025. Although the visible tumor was completely removed, the operation resulted in irreversible and lifelong physical impairment. After surgery, the chest wall collapsed and became deformed, causing a marked imbalance in body posture. With only one lung remaining, his pulmonary function declined dramatically. Even walking slowly on level ground caused chest tightness and shortness of breath. He suffered from persistent generalized body aches, severe fatigue, a significant decline in immune function, and recurrent respiratory tract infections. His daily activities became increasingly restricted, while both his physical and psychological well-being were profoundly affected, causing his quality of life to deteriorate dramatically. Even more regrettably, such an extensive surgical resection failed to halt the progression of the disease. A follow-up PET-CT performed six months after surgery revealed brain metastasis in the left frontal lobe together with multiple bone metastases throughout the body. Subsequent follow-up examinations showed continued disease progression. In April 2026, brain MRI demonstrated multiple newly developed intracranial metastatic lesions accompanied by severe peritumoral edema. Leptomeningeal metastasis involving the cerebellum compressed adjacent nerves, resulting in numbness and weakness of the right arm, with complete inability to raise it, while the patient's condition continued to worsen.

2. Traveling Thousands of Kilometers to Guangzhou: Precision Radiotherapy Reversed Critical Neurological Symptoms

Unable to endure the relentless progression of his illness, the patient traveled to our hospital in May 2026 to seek further treatment. After a comprehensive review of his medical history, imaging studies, pathology reports, and previous surgical records, our multidisciplinary team (MDT) reached a crucial conclusion: the patient had not required complete removal of the entire lung at the time of his initial treatment. According to current evidence-based treatment principles, the recommended approach would have been neoadjuvant chemoradiotherapy to reduce the tumor burden, followed by video-assisted thoracoscopic (VATS) resection of the affected pulmonary lobe, preserving the remaining healthy lung tissue. Such a strategy could not only achieve radical treatment of the primary tumor but also preserve normal pulmonary function and fundamentally avoid the long-term complications associated with total pneumonectomy. Cases of overtreatment through extensive pneumonectomy remain common in parts of Central Asia. Limitations in local treatment techniques and therapeutic decision-making mean that many patients with lung cancer undergo unnecessarily extensive surgery, resulting in substantial surgical trauma, impaired organ function, and failure to effectively prevent distant metastasis, while losing the opportunity to benefit from lung-preserving minimally invasive surgery with more favorable long-term outcomes.

Figure 1. Department Director conducting bedside rounds following the patient's admission

Taking into account the patient's critical condition—including multiple brain metastases, leptomeningeal metastasis, and widespread bone metastases—our hospital's multidisciplinary oncology team (MDT) conducted a comprehensive evaluation of the disease, the patient's overall physical condition, and treatment tolerance before formulating a personalized treatment strategy. The team selected the HyperArc stereotactic cranial radiotherapy system, an advanced radiotherapy platform specifically designed for patients with multiple intracranial metastatic tumors. Powered by its proprietary single-isocenter — multiple-target technology, HyperArc can simultaneously target dozens of brain metastases of varying sizes, delivering highly precise treatment to all lesions in a single session of approximately 10 minutes, thereby significantly reducing overall treatment time. With submillimeter accuracy, the system maximizes protection of surrounding healthy brain tissue, precisely controls radiation exposure to normal structures, minimizes radiation-related neurological side effects, and helps preserve brain function. Throughout the entire course of treatment, the patient also received immune-supportive therapy with Thymosin α1 (Zadaxin) to enhance immune function and improve tolerance to comprehensive anticancer treatment.

Figure 2. Following treatment, the patient regained normal ability to raise his right arm

After the sixth radiotherapy session, the persistent numbness in the patient's right hand, which had troubled him for a long time, was significantly relieved. By the ninth session, the right arm - which had previously been weak, difficult to lift, and severely restricted in movement - had regained the ability to raise normally and move freely. On June 4, 2026, the entire course of cranial radiotherapy was successfully completed. Follow-up brain CT demonstrated a marked reduction in the size of the intracranial metastatic lesions compared with pretreatment findings. Cerebral edema was effectively controlled, and the neurological symptoms caused by nerve compression were substantially alleviated.

3. Rejecting the “One-Size-Fits-All” Approach: Individualized Minimally Invasive Treatment to Preserve Quality of Life

There is no universal treatment template for lung cancer, and total pneumonectomy is by no means the preferred treatment for patients with early-stage localized lung cancer. At Jinshazhou Hospital of Guangzhou University of Chinese Medicine, we adhere to the principle of individualized treatment for every patient. By integrating advanced technologies such as video-assisted thoracoscopic surgery (VATS) and precision stereotactic radiotherapy, we strive to eradicate cancer while preserving as much healthy lung tissue and normal organ function as possible. This approach significantly reduces surgical trauma, minimizes long-term postoperative complications, and balances effective tumor control with the preservation of patients' mobility, independence, and overall quality of life.
For the many international patients who travel long distances to seek treatment at our hospital, we bring together specialists from thoracic surgery, radiation oncology, medical oncology, imaging, and pathology through our multidisciplinary team (MDT). By addressing the three fundamental goals of tumor eradication, organ preservation, and quality of life, we provide patients from China and around the world with a safer, gentler, and more patient-centered one-stop cancer care solution.