Chowdhary Rahul Lal, Chufal Kundan Singh, Pahuja Anjali Kakria, Bhushan Manindra, Singh Rajpal, Ahmad Irfan
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India.
BMJ Case Rep. 2019 Mar 21;12(3):e227128. doi: 10.1136/bcr-2018-227128.
A middle-aged man presented with progressively worsening breathlessness and non-productive cough for the last 3 months. On examination, his breathing was stridulous and air entry was decreased bilaterally. He underwent emergency fibre-optic bronchoscopy, which revealed a tracheal growth causing luminal narrowing, and after tumour debulking, he improved symptomatically. Histopathological evaluation of the specimen revealed an adenoid cystic carcinoma of the trachea, and systemic evaluation revealed metastatic dissemination. Systemic molecular-targeted therapy was initiated (gefitinib and later imatinib mesylate) and continued for 5 years, in view of stable disease on periodic follow-up. He subsequently presented with breathlessness again, which was managed with an emergency tracheostomy. In view of stable systemic disease and local progression only, he received definitive radiotherapy with image-guided volumetric modulated arc therapy, which resulted in a complete radiological response. The patient has been disease-free for the last 9 months.
一名中年男性在过去3个月中出现进行性加重的呼吸困难和干咳。检查时，他呼吸时有喘鸣音，双侧呼吸音减弱。他接受了紧急纤维支气管镜检查，发现气管内有肿物导致管腔狭窄，肿瘤减容后症状有所改善。标本的组织病理学评估显示为气管腺样囊性癌，全身评估发现有转移扩散。鉴于定期随访中病情稳定，开始进行全身分子靶向治疗（吉非替尼，后来使用甲磺酸伊马替尼）并持续了5年。他随后再次出现呼吸困难，通过紧急气管切开术进行处理。鉴于仅存在稳定的全身疾病和局部进展，他接受了图像引导的容积调强弧形放疗，取得了完全的影像学缓解。该患者在过去9个月中一直无病生存。
