Boon Ian S, Boon Cheng S
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Oncology Department, Worcestershire Acute NHS Trust, Worcester, UK.
BMJ Case Rep. 2016 Feb 25;2016:bcr2015214236. doi: 10.1136/bcr-2015-214236.
A 70-year-old man newly diagnosed with metastatic gastric adenocarcinoma was started on standard first-line palliative chemotherapy with anthracycline (epirubicin), platinum (oxaliplatin) and fluoropyrimidine (capecitabine); EOX combination chemotherapy. 5 days after the first cycle of chemotherapy, he presented with tachycardia with associated severe abdominal and lumbar pains. Initial investigations confirmed life-threatening metabolic acidosis with serum lactate of 9.7 mmol/L (normal range 0.5-2.2 mmol/L). CT angiogram identified acute arterial thrombosis within the abdominal aorta, lumbar and right common iliac artery, which was absent on staging contrast CT scan 6 weeks prior. The patient was immediately anticoagulated and chemotherapy discontinued. Urgent oncology and surgical opinions advised conservative management. The patient responded well to early treatment and survived this acute episode. He was subsequently started on life-long treatment dose enoxaparin and second-line single agent chemotherapy with docetaxel (taxotere), with no reported complications.
一名新诊断为转移性胃腺癌的70岁男性患者开始接受标准的一线姑息化疗，使用蒽环类药物（表柔比星）、铂类药物（奥沙利铂）和氟嘧啶（卡培他滨）；即EOX联合化疗。化疗第一周期后5天，他出现心动过速，并伴有严重的腹部和腰部疼痛。初步检查证实存在危及生命的代谢性酸中毒，血清乳酸水平为9.7 mmol/L（正常范围0.5 - 2.2 mmol/L）。CT血管造影显示腹主动脉、腰动脉和右髂总动脉内有急性动脉血栓形成，而6周前的分期增强CT扫描未发现此情况。患者立即接受抗凝治疗，化疗中断。紧急咨询肿瘤学和外科专家后建议采取保守治疗。患者对早期治疗反应良好，度过了这一急性发作期。随后他开始接受终身治疗剂量的依诺肝素以及多西他赛（泰索帝）二线单药化疗，未报告有并发症。
