Stage IIIB pulmonary sarcomatoid carcinoma treated with spatially fractionated radiotherapy combined with antiangiogenic therapy and sequential chemo‑immunotherapy: A case report

Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non‑small‑cell lung cancer, characterized by high invasiveness and treatment resistance. Patients with PSC often exhibit poor treatment outcomes, short median survival and a dismal prognosis, necessitating novel comprehensive treatment strategies to address this clinical challenge. A 64‑year‑old man with PSC was initially diagnosed with stage cT4N2M0 IIIB disease and was negative for programmed cell death‑ligand 1 expression. Owing to the large tumor size and unfavorable performance status, treatment initially involved an induction regimen that combined tomotherapy‑based spatially fractionated radiotherapy (SFRT) with recombinant human endostatin injection (Endostar). As the condition of the patient improved, two additional cycles of low‑dose albumin‑bound paclitaxel were administered as concurrent chemoradiotherapy. Following radiotherapy, the patient received two sequential cycles of systemic therapy with paclitaxel liposome and ivonescimab. This combined regimen demonstrated favorable short‑term efficacy with improved performance status. However, the patient developed pneumonia caused by infection with Pneumocystis jirovecii and aspergillus, subsequently succumbing to respiratory failure (with an overall survival of 5.5 months). The present case provides a clinical reference for the selection of treatment strategies in locally advanced, large PSC, highlighting the potential of SFRT combined with antiangiogenic therapy as a promising, novel local treatment option. However, the ultimate survival outcome of this patient should serve as a stark warning that heightened vigilance against opportunistic infections is essential during combination therapy in such patients.