Pezzuto Aldo, Terzo Fabrizio, Graziani Maria Laura, Ricci Alberto, Bruno Pierdonato, Mariotta Salvatore
Department of Cardiovascular and Thoracic Disease, Division of Pulmonology, St. Andrew's Hospital, I-00189 Rome, Italy.
Department of Clinical and Molecular Medicine, Sapienza University of Rome, I-00189 Rome, Italy.
Oncol Lett. 2017 Sep;14(3):3035-3038. doi: 10.3892/ol.2017.6511. Epub 2017 Jun 30.
The present study reports two cases of lung cancer with the involvement of the pleura. The diagnosis of adenocarcinoma with epidermal growth factor receptor (EGFR) mutation was made following repeated thoracentesis with cytology of pleural fluid and thoracoscopy with pleural biopsies. Talc pleurodesis was successfully performed in both cases subsequent to diagnosis. Following talc pleurodesis, the first patient (62 years old; male; non-smoker) underwent 3 cycles of cisplatin/vinorelbine chemotherapy, with a poor response. Concurrently, due to the presence of an EGFR mutation, treatment with gefitinib was initiated, with the patient achieving a good response for ~12 months. The residual tumor was treated with stereotactic radiotherapy and the patient continued gefitinib treatment. The patient is presently in good health, has not exhibited any signs of relapse and is continuing gefitinib treatment without side effects. The second patient (53 years old; male ex-smoker) underwent treatment with gefitinib subsequent to talc pleurodesis for a total of 15 months. In addition, radiotherapy (60 Gy) on the residual lesion was performed. Subsequently, second-line therapy with cisplatin/premetrexed was prescribed and followed by maintenance treatment with premetrexed. Three years after diagnosis, the patient did not exhibit any signs of recurrence. These two cases highlight the difficulty in treating advanced stage lung cancer, despite the presence of EGFR mutation. Each lung cancer is different and requires the physician to possess a wide range of knowledge of the therapeutic options available, in addition to careful monitoring in order to adjust the treatment over time. A multidisciplinary approach, involving surgeons, radiation oncologists, pulmonologists and oncologists, is required to optimize the survival and quality of life of patients with lung cancer.
本研究报告了两例累及胸膜的肺癌病例。通过反复胸腔穿刺抽取胸水进行细胞学检查以及胸腔镜胸膜活检，确诊为具有表皮生长因子受体（EGFR）突变的腺癌。确诊后，两例患者均成功进行了滑石粉胸膜固定术。滑石粉胸膜固定术后，首例患者（62岁；男性；不吸烟者）接受了3个周期的顺铂/长春瑞滨化疗，但反应不佳。同时，由于存在EGFR突变，开始使用吉非替尼治疗，患者获得了约12个月的良好反应。残余肿瘤采用立体定向放射治疗，患者继续接受吉非替尼治疗。该患者目前健康状况良好，未出现任何复发迹象，且在持续接受吉非替尼治疗且无副作用。第二例患者（53岁；男性，既往吸烟者）在滑石粉胸膜固定术后接受了总共15个月的吉非替尼治疗。此外，对残余病灶进行了放疗（60 Gy）。随后，给予顺铂/培美曲塞二线治疗，之后采用培美曲塞维持治疗。确诊三年后，该患者未出现任何复发迹象。这两例病例凸显了晚期肺癌治疗的困难，尽管存在EGFR突变。每例肺癌都各不相同，要求医生除了仔细监测以便随时间调整治疗外，还需具备广泛的可用治疗方案知识。需要外科医生、放射肿瘤学家、肺科医生和肿瘤学家参与的多学科方法，以优化肺癌患者的生存率和生活质量。
