Pneumothorax triggered by EGFR-tyrosine kinase inhibitors in three microwave ablation candidates: A review of the literature.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used in patients with EGFR-mutant lung cancer. Meanwhile, thermal ablation such as microwave ablation has been an option for selected patients. Herein, we describe three cases of pneumothorax that occurred in microwave ablation (MWA) candidates treated with EGFR-TKIs. The three patients developed pneumothorax in different periods: case 1 developed pneumothorax two months after MWA and subsequent gefitnib therapy; case 2 took osimertinib for two years and developed pneumothorax before MWA; case 3 took gefitinb for 13 months and experienced bronchopleural fistula after MWA. Although a causal relationship is uncertain, the risk of pneumothorax for these MWA candidates should be considered. KEY POINTS: Microwave ablation candidates treated with epidermal growth factor receptor tyrosine kinase inhibitors are more likely to suffer pneumothorax. The risk of delayed pneumothorax or even bronchopleural fistula in patients pretreated with tyrosine kinase inhibitors should be taken into consideration when selecting patients and performing microwave ablations.