本文介绍了一个多学科团队(MDT)讨论和综合治疗一例晚期胃癌的过程,该胃癌的程序性死亡配体1(PD-L1)检测呈阳性。在诊断过程中,患者表现为晚期胃癌和小网膜淋巴结中许多不可切除的转移,双肺,肝脏,和左侧顶叶枕叶。为肿瘤科安排了一次会议,胃肠手术,放射治疗,成像,和病理学来讨论这个案子。最初,患者对一线治疗有部分反应,这是pembrolizumab和化疗的组合。然而,十九个月后,患者出现左额叶异时孤立性病变。肿瘤科双方达成协议后,脑部手术,胃肠手术,放射治疗,成像,还有病理科,颅内病变行切除。在此之后,手术辅以立体定向放射治疗(SRT)和全脑放射治疗(WBRT).病人在手术后表现出极好的康复迹象,经过16个月的随访,她的一般状况仍然良好。尽管如此,晚期胃癌患者的前景仍然令人沮丧.通过多学科团队(MDT)讨论,诊断为晚期胃癌的患者可以接受规范化的诊断和治疗方法,制定合理、个性化的综合治疗方案。这样的计划有助于提高患者的生活质量,有效延长患者的生存时间。
This article describes the process of multidisciplinary team (MDT) discussion and comprehensive treatment of a case of advanced gastric cancer that tested positive for programmed death ligand 1 (PD-L1). During diagnosis, the patient presented with advanced gastric cancer and numerous unresectable metastases in the lesser omental lymph nodes, both lungs, liver, and left parietal occipital lobe. A meeting was arranged for the departments of oncology, gastrointestinal surgery, radiotherapy, imaging, and pathology to discuss the case. Initially, the patient had a partial response to the first-line treatment, which was a combination of pembrolizumab and chemotherapy. However, after nineteen months, the patient presented with a metachronous isolated lesion in the left frontal lobe. After mutual agreement among the oncology, brain surgery, gastrointestinal surgery, radiotherapy, imaging, and pathology departments, the intracranial lesion underwent resection. Following this, the operation was supplemented by stereotactic radiation therapy (SRT) and whole-brain radiation therapy (WBRT). The patient showed excellent signs of recovery after the operation, and her general condition remained favorable after 16 months of follow-up. Nonetheless, the outlook for patients facing advanced-stage gastric cancer remains distressing. Through multidisciplinary team (MDT) discussions, patients diagnosed with advanced gastric cancer can receive standardized diagnostic and treatment approaches to develop reasonable and personalized comprehensive treatment plans. Such plans help to improve the quality of life of patients and effectively prolong their survival time.