Liu Lingxiao, Han Xu, Lou Wenhui
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Transl Gastroenterol Hepatol. 2016 Sep 23;1:74. doi: 10.21037/tgh.2016.09.02. eCollection 2016.
A 42-year-old male patient was admitted due to altered bowel habit for 1 month and liver metastases found during health check-up 1 week ago. Thin stools form with reduced defecation frequency, and weight loss have been observed. Digital rectal exam found a 2-3 cm soft, clear boundary mass 5 cm above the anal verge, and colonoscopic biopsy identified this rectal tumor as nonfunctional neuroendocrine tumor (G1). Computed tomography imaging showed multiple liver metastases with rich blood supply, and the tumor burden exceeded 70%. As indicated by multidisciplinary treatment (MDT) consultations, the patient had lost the chance for radical surgery. Interventional therapy has been chosen for liver metastases and primary tumor, during which liver biopsy was performed suggesting liver metastases as neuroendocrine tumor (G2). Interventional therapy included percutaneous transcatheter arterial chemoembolization (TACE) and transcatheter arterial infusion (TAI) chemotherapy; the following chemotherapeutic agents were selectively used: oxaliplatin, irinotecan, epirubicin and Lipiodol. After the 9th intervention, imaging evaluation indicated that liver metastases were obviously shrank, although the rectal lesion was still same as before. Currently the patient survived for nearly 2 years from baseline and was still under frequent observation. We concluded that interventional therapy targeting liver metastases and primary lesion in patients with advanced rectal neuroendocrine tumors NETs could control tumor progression and prolong the survival.
一名42岁男性患者因排便习惯改变1个月，于1周前健康体检时发现肝转移入院。观察到大便变细、排便次数减少及体重减轻。直肠指检发现距肛缘5 cm处有一2 - 3 cm质地柔软、边界清晰的肿块，结肠镜活检确定该直肠肿瘤为无功能神经内分泌肿瘤（G1）。计算机断层扫描成像显示肝脏有多处血供丰富的转移灶，肿瘤负荷超过70%。多学科治疗（MDT）会诊表明，患者已失去根治性手术机会。已选择对肝转移灶和原发肿瘤进行介入治疗，其间进行了肝活检，提示肝转移灶为神经内分泌肿瘤（G2）。介入治疗包括经皮经导管动脉化疗栓塞术（TACE）和经导管动脉灌注（TAI）化疗；选择性使用了以下化疗药物：奥沙利铂、伊立替康、表柔比星和碘油。第9次介入治疗后，影像学评估表明肝转移灶明显缩小，尽管直肠病灶仍与之前相同。目前，患者自基线起已存活近2年，仍在接受密切观察。我们得出结论，针对晚期直肠神经内分泌肿瘤（NETs）患者的肝转移灶和原发灶进行介入治疗可控制肿瘤进展并延长生存期。
