Abstract：
Although the treatment of aspergillosis has been studied for years, the optimal nonsurgical treatment of chronic cavitary pulmonary aspergillosis (CCPA) remains unsatisfactory, especially in lung cancer. We report two advanced non-small cell lung cancer (NSCLC) patients who recovered from CCPA following instillation of Amphotericin B (AmB) by bronchoscopy combined with systemic voriconazole. The first patient was diagnosed with lung adenocarcinoma after right upper lobe resection and was treated with anaplastic lymphoma kinase-targeted therapy. Chest computed tomography (CT) revealed a right pulmonary cavity containing solid materials. The second patient was diagnosed with squamous cell carcinoma and received immunotherapy following surgery, chemotherapy, and radiotherapy. Chest CT tomography revealed a mass in the right lung cavity. Both patients\' cultures and next-generation sequencing of their bronchoalveolar lavage (BAL) samples revealed presence of Aspergillus fumigatus. In addition, the galactomannan test of both patients BAL samples was positive. Systemic voriconazole was prescribed based on in vitro susceptibility testing. The chest images and clinical symptoms of both patients did not improve after one month of voriconazole therapy within the therapeutic blood concentration. Considering the low local concentrations of antifungals against CCPA, AmB instillation by bronchoscopy combined with systemic voriconazole was utilized. The chest CT images and clinical symptoms of both patients markedly improved in the following third month. Instillation of AmB combined with systemic voriconazole may be a promising treatment option for NSCLC patients with CCPA who fail voriconazole monotherapy.
摘要：
尽管曲霉菌病的治疗已经研究了多年，慢性空洞性肺曲霉病（CCPA）的最佳非手术治疗仍不能令人满意，尤其是肺癌。我们报告了两名晚期非小细胞肺癌（NSCLC）患者，他们通过支气管镜滴注两性霉素B（AmB）并联合全身伏立康唑后从CCPA康复。第一例患者在右上叶切除术后被诊断为肺腺癌，并接受了间变性淋巴瘤激酶靶向治疗。胸部计算机断层扫描（CT）显示右肺腔中含有固体物质。第二例患者被诊断为鳞状细胞癌，并在手术后接受了免疫治疗，化疗,和放射治疗。胸部CT断层扫描显示右肺腔有肿块。两名患者的培养和支气管肺泡灌洗（BAL）样品的下一代测序均显示存在烟曲霉。此外,两名患者BAL样本的半乳甘露聚糖试验均为阳性.根据体外药敏试验规定全身伏立康唑。在治疗血药浓度范围内，伏立康唑治疗一个月后，两名患者的胸部图像和临床症状均未改善。考虑到抗CCPA的抗真菌药局部浓度低，使用支气管镜下AmB滴注联合全身伏立康唑。两个患者的胸部CT图像和临床症状在随后的第三个月均有明显改善。对于伏立康唑单药治疗失败的CCPANSCLC患者，滴注AmB联合全身性伏立康唑可能是一种有希望的治疗选择。
