背景:在有限数量的部位出现疾病进展模式,称为寡头进展,在肺癌患者的免疫治疗过程中比较常见。如何处理临床上有问题的少进展性病变是有争议的,如对免疫疗法有抗性的上腔静脉(SVC)阻塞。
方法:我们介绍了一例43岁男性,表现为面部肿胀和右肩疼痛。对比增强计算机断层扫描(CT)显示右肺尖部有肿瘤,肺和胸膜结节,纵隔淋巴结肿大.纵隔淋巴结肿大直接侵入SVC。淋巴结病理诊断为腺癌。根据这些发现,患者被诊断为肺腺癌伴SVC梗阻(cT3N2M1c;IVB期).卡铂一线化疗,培美曲塞,派姆单抗缩小了原发肿瘤的大小,肺和胸膜转移瘤,四个周期的治疗后,大部分纵隔淋巴结转移,但是一个侵犯SVC的病变增加了。因此,手术切除病灶并进行血管置换。目前,手术已经过去了22个月,培美曲塞和派博利珠单抗的维持治疗正在进行中,无疾病进展或任何不良事件。
结论:本文介绍的病例的临床过程表明,姑息性手术可能是临床上有问题的病变的有效治疗选择,例如SVC阻塞,在免疫疗法期间增加。
A disease progression pattern in a limited number of sites, called
oligoprogression, is relatively common in patients with lung cancer during immunotherapy. It is controversial how to manage clinically problematic oligoprogressive lesions, such as superior vena cava (SVC) obstruction resistant to immunotherapy.
We present a
case of a 43-year-old man who presented with facial swelling and pain in the right shoulder. Contrast-enhanced computed tomography (CT) revealed a tumor at the apex of the right lung, pulmonary and pleural nodules, and swollen mediastinal lymph nodes. A swollen mediastinal lymph node directly invaded into the SVC. Pathological diagnosis of the lymph node revealed adenocarcinoma. On the basis of these findings, the patient was diagnosed with lung adenocarcinoma with SVC obstruction (cT3N2M1c; stage IVB). First-line chemotherapy with carboplatin, pemetrexed, and pembrolizumab reduced the size of the primary tumor, pulmonary and pleural metastases, and most mediastinal lymph node metastases after four cycles of treatment, but one lesion invading the SVC increased. Therefore, surgical resection of the lesion and vascular replacement were performed. At present, 22 months have passed since the surgery, and maintenance therapy with pemetrexed and pembrolizumab is ongoing, without disease progression nor any adverse events.
The clinical course of the
case presented here suggests that palliative surgery may be an effective management option for a clinically problematic lesion, such as SVC obstruction, which increases during immunotherapy.