Bednaríková M, Valík D, Vyzula R
Klinika komplexní onkologické péce, Masarykův, onkologický ustav, Brno.
Cas Lek Cesk. 2008;147(4):233-5.
The patient--born in 1960, was first diagnosed in 1981 as having malignant carcinoid of the right lung. The disease relapsed in 2002 in a form of distant dissemination. According to tumor histology--atypical carcinoid--this patient was initially treated with palliative systemic chemotherapy, specifically with cisplatin and etoposid. His disease stabilized after administration of 4 cycles of chemotherapy. The treatment was accompanied by protracted toxicity with marked alteration of his general conditions after the 4th cycle. Upon request of his relatives, the patient was referred to Masaryk Memorial Cancer Institute to receive supportive care. His general conditions then stabilized but intermittent episodic abdominal discomfort with occasional vomiting persisted. Due to positive octreoscan, the patient was given somatostatin analogues with a very good and long-term clinical effect. The symptoms disappeared, except a persisting ocular disorder due to periorbital infiltration. The patient state improved allowing further outpatient care. When somatostatin analogues were discontinued, serum chromogranin A rose rapidly and was accompanied by new appearance of symptoms. After re-administering somatostatin analogues the symptoms disappeared and the concentration of serum chromogranin A decreased. The patient has been still (with two 5,5 years interruptions) treated with somatostatin analogues with very good tolerance and clinical effect--at present there are no symptoms of the disease and, according to imaging methods, long-term stabilization continues. This case study illustrates the necessity of cautious and individual approach to the choice of treatment strategy in patients with malignant carcinoid.
该患者于1960年出生，1981年首次被诊断为右肺恶性类癌。2002年疾病以远处转移的形式复发。根据肿瘤组织学——非典型类癌——该患者最初接受姑息性全身化疗，具体使用顺铂和依托泊苷。在给予4个周期化疗后，他的病情稳定。治疗过程中伴有长期毒性反应，第4个周期后其一般状况明显改变。应其亲属要求，该患者被转诊至马萨里克纪念癌症研究所接受支持性治疗。他的一般状况随后稳定，但间歇性发作的腹部不适伴偶尔呕吐仍持续存在。由于奥曲肽扫描呈阳性，该患者接受了生长抑素类似物治疗，临床效果非常好且持久。症状消失，除了因眶周浸润导致的持续性眼部疾病。患者状态改善，可接受进一步的门诊治疗。当停用生长抑素类似物时，血清嗜铬粒蛋白A迅速升高，并伴有新症状出现。重新给予生长抑素类似物后，症状消失，血清嗜铬粒蛋白A浓度降低。该患者仍在接受（有两次5.5年的中断）生长抑素类似物治疗，耐受性和临床效果都非常好——目前没有疾病症状，根据影像学方法，病情仍长期稳定。本病例研究说明了在恶性类癌患者治疗策略选择上谨慎和个体化方法的必要性。
