Necrotic lung and bronchopleural fistula as complications of therapy in lung cancer

Seven patients developed a lung abscess and bronchopleural fistula after undergoing aggressive treatment of their lung cancer with radiotherapy +/- chemotherapy. These complications were preceded by a prodrome of recurrent bronchitis with increasing refractoriness to antibiotics, weight loss, fever, and generalized debilitation. Delays in definitive diagnosis and treatment often resulted from concern about the patients guarded cancer prognosis and misinterpretation of involved areas on x-rays and scans as being secondary to cancer rather than manifestations of treatment toxicity. Early surgical treatment utilizing local muscular flaps for bronchial stump reinforcement and restoration of chest wall continuity can successfully remedy these complications.