Omoto Hideyuki, Takada Mamoru, Fujii Shota, Ito Hiroshi, Yamashita Sumio
Dept. of Surgery, Fukaya Red Cross Hospital.
Gan To Kagaku Ryoho. 2019 Jan;46(1):160-162.
We report the case of a 60-year-old woman with right breast cancer. Approximately 18 years had passed since the treatment for left breast cancer without recurrence. She became aware of the right breast tumor with mild pain 5 months before she came to the hospital. The diagnosis was right-sided breast cancer, cT2N0M0, StageⅡA, ER(-), PgR(-), HER2(-). Neoadjuvant chemotherapy was chosen, and then combined treatment with epirubicin(EPI)and cyclophosphamide(CPA) was started. The breast tumor had become smaller, but she complained of shortness of breath during the third course of chemotherapy. On the basis of her history of cancer onset, chest CT findings, and increase in serum SP-D levels, the combined therapy with EPI and CPA was suspected as the cause of the drug-induced interstitial lung disease(DILD). For this reason, the therapy was discontinued. After her recovery from this state, the operation(partial mastectomy and sentinel lymph node biopsy)was performed. S-1 was used as postoperative adjuvant therapy, and the respiratory symptoms did not recur or worsen. On the basis of the disease course, we made a diagnosis of DILD with EPI and CPA. Many anticancer drugs may cause DILD. In case of a suspicion of DILD onset, a prompt diagnosis and an appropriate treatment are important.
我们报告一例60岁右乳腺癌女性患者。自左侧乳腺癌治疗后约18年无复发。她在入院前5个月发现右乳肿物并伴有轻度疼痛。诊断为右侧乳腺癌，cT2N0M0，ⅡA期，ER(-)，PgR(-)，HER2(-)。选择新辅助化疗，随后开始表柔比星（EPI）和环磷酰胺（CPA）联合治疗。乳腺肿瘤变小，但她在化疗第三疗程时出现气短症状。基于其癌症发病史、胸部CT检查结果以及血清SP-D水平升高，怀疑EPI和CPA联合治疗是药物性间质性肺病（DILD）的病因。因此，停止该治疗。待她从该状态恢复后，进行了手术（部分乳房切除术和前哨淋巴结活检）。术后辅助治疗采用S-1，呼吸症状未复发或加重。根据病程，我们诊断为EPI和CPA所致的DILD。许多抗癌药物可能导致DILD。怀疑发生DILD时，及时诊断和恰当治疗很重要。
