PDF(Pubmed)
Abstract：
The patient was a 74-year-old woman who was diagnosed with lung adenocarcinoma, clinical Stage IIIA. Induction chemoradiation was performed followed by right upper lobectomy and lymph node dissection. Because of positive pleural effusion cytology, which was proven after surgery, the patient was diagnosed with pathological Stage IVA with EGFR L858R mutation. At 17 months after the administration of gefitinib, left choroidal metastasis appeared. Stereotactic irradiation and ruthenium small-beam radiation were effective; however, the metastatic lesion showed regrowth 7 months after these treatments. Because the patient\'s choroidal oligometastasis was resistant to conservative therapy, left ophthalmectomy was performed. EGFR mutations (L858R and E709K) were detected in the resected choroidal tumor. The patient continued to take gefitinib. However, a neoplastic lesion developed on the optic nerve adjacent to the resected posterior eye segment. The lesion was treated with stereotactic radiation, gefitinib was switched to afatinib 30 mg, and the patient remains alive and disease free for 11 months.
摘要：
患者是一名74岁的女性，被诊断为肺腺癌，临床IIIA期。进行诱导放化疗，然后进行右上叶切除和淋巴结清扫。因为胸腔积液细胞学检查阳性，手术后证明了这一点，患者被诊断为病理IVA期伴EGFRL858R突变.吉非替尼给药后17个月，出现左侧脉络膜转移。立体定向辐射和钌小束辐射是有效的；然而，这些治疗后7个月，转移性病变显示出再生。因为患者的脉络膜寡转移对保守治疗有抵抗力，进行左眼切除术。在切除的脉络膜肿瘤中检测到EGFR突变（L858R和E709K）。患者继续服用吉非替尼。然而,在切除的后眼节附近的视神经上出现了肿瘤性病变。病灶接受了立体定向放射治疗,吉非替尼改用阿法替尼30毫克，病人存活11个月，没有疾病。
