Rischke H C, Staib-Sebler E, Mose S, Adams S W, Herrmann G, Böttcher H D, Lorenz M
Klinik für Strahlentherapie und Onkologie, Johann-Wolfgang-Goethe-Universität Frankfurt/Main.
Dtsch Med Wochenschr. 1999 Feb 19;124(7):182-6. doi: 10.1055/s-2007-1024271.
A 75-year-old woman with histologically confirmed liver metastases from an undiagnosed primary tumor was admitted for further diagnosis and treatment. She had no symptoms and was in a very good general condition. The physical examination was unremarkable.
The liver enzymes GOT and GPT were slightly elevated. The carcinoembryonic antigen (CEA) and the erythrocyte sedimentation rate (ESR) were markedly raised. Repeat analysis of the liver biopsies revealed a carcinoma with neuroendocrine differentiation (carcinoid).
Chemoembolization of the advanced liver metastases was undertaken. Subsequently the breast tumor was resected. Histological analysis revealed a mammary carcinoma with neuroendocrine differentiation. Postoperative radiotherapy to the breast was instituted and she was started on tamoxifen (30 mg daily). But despite repeat chemoembolization the liver metastases continued to grow. Administration of octreotide, a somatostatin analogue, was begun (200 micrograms twice daily). There were no side effects; the tumor markers showed definite reduction and scintigraphy demonstrated almost complete regression. Computed tomography indicated a dissociated response of the liver metastases to the treatment (some got smaller, one had grown and several new ones had appeared).
Combined tamoxifen and octreotide treatment of a metastasizing carcinoma of the breast with neuroendocrine differentiation may give effective palliation.
一名75岁女性，组织学检查证实存在来自未确诊原发肿瘤的肝转移，因进一步诊断和治疗入院。她没有症状，一般状况良好。体格检查无异常。
肝酶谷草转氨酶（GOT）和谷丙转氨酶（GPT）轻度升高。癌胚抗原（CEA）和红细胞沉降率（ESR）显著升高。对肝活检组织的重复分析显示为具有神经内分泌分化的癌（类癌）。
对晚期肝转移灶进行了化疗栓塞。随后切除了乳腺肿瘤。组织学分析显示为具有神经内分泌分化的乳腺癌。对乳房进行了术后放疗，并开始给予他莫昔芬（每日30毫克）。但尽管重复进行化疗栓塞，肝转移灶仍继续生长。开始给予生长抑素类似物奥曲肽（每日两次，每次200微克）。未出现副作用；肿瘤标志物显示明显下降，闪烁扫描显示几乎完全消退。计算机断层扫描显示肝转移灶对治疗的反应不一致（一些变小了，一个增大了，还出现了几个新的转移灶）。
他莫昔芬和奥曲肽联合治疗具有神经内分泌分化的转移性乳腺癌可能会带来有效的姑息治疗效果。
