An elderly patient had been coughing up blood for several years when a chest CT scan revealed a tumor in the lower lobe of the left lung. On March 9, 2009, she underwent a left lower lobectomy, and pathology confirmed mucinous adenocarcinoma of the left lower lung, stage T2N0M0 (stage Ib).

During a CT scan in 17 September, 2013, a 1.3 cm nodule was detected in the left upper lung. By January 10, 2016, the nodule had grown larger with spiculated margins, highly suggestive of lung cancer. On March 28, 2016, the patient received CyberKnife stereotactic radiosurgery under the care of Professor Wang Enmin at Huashan Hospital, achieving excellent post-treatment results and recovery.

A follow-up CT scan in May 7, 2019 revealed a 0.6 cm nodule in the apicoposterior segment of the left upper lobe. By September 19, 2021, imaging showed that the nodule had enlarged to 1.6 × 1.5 cm and developed cavitation. PET-CT reported an irregular solid nodule with lobulated, spiculated margins and multiple internal vacuoles, measuring 2.1 × 1.9 × 2.2 cm, with mild FDG uptake—highly suspicious for primary lung cancer. On November 10, 2021, the patient underwent a second CyberKnife treatment, again with good results.

On April 10, 2025, a follow-up CT scan showed a 3.0 × 2.6 cm patchy opacity with ill-defined borders, spiculations, and pleural traction—raising the question: Is this a recurrence or radiation-induced fibrosis? The patient is currently in good health and has no discomfort.

The patient's family wrote to me:

“Professor Wang, given my mother's current condition, how should we proceed? We would greatly appreciate your advice.”

I advised the family to perform a whole-body PET-CT to determine whether the lesion shows metabolic activity. If there is no metabolic uptake, the finding likely represents radiation-induced changes. If metabolic activity is present, it may indicate tumor recurrence, in which case another round of CyberKnife therapy could be considered.

Remarkably, the patient has been living a high-quality life for nine years since her first CyberKnife treatment.