帕博利珠单抗联合放疗后晚期升结肠癌患者结肠十二指肠瘘完全闭合：一例报告
Complete closure of a colo-duodenal fistula in a patient with advanced ascending colon cancer after pembrolizumab combined with radiation therapy: a case report.
作者信息
Tominaga Tetsuro, Nonaka Takashi, Fukuda Akiko, Moriyama Masaaki, Oyama Shosaburo, Ishii Mitsutoshi, Nishimuta Masato, Fujise Yuta, Sawai Terumitsu, Nagayasu Takeshi
机构信息
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
出版信息
Surg Case Rep. 2021 Jul 16;7(1):168. doi: 10.1186/s40792-021-01248-x.
BACKGROUND
A colo-duodenal fistula is a very rare complication of colon cancer that presents with not only severe clinical symptoms, but a poor prognosis due to locally advanced cancer. A novel immune checkpoint inhibitor for colon cancer patients provides a high objective response rate. Recently, radiation therapy combined with immune checkpoint inhibitor therapy has been reported to have a synergistic antitumor effect. A case of complete closure of a colo-duodenal fistula in a patient with locally advanced colon cancer after combined pembrolizumab and radiation therapy is reported.
CASE PRESENTATION
A 66-year-old man presented with abdominal distention. Abdominal contrast-enhanced computed tomography (CT) showed a 80-mm bulky mass in the right upper quadrant. The tumor created a fistula to the second portion of the duodenum. Upper gastrointestinal endoscopy showed a colo-duodenal fistula. Gastro-jejunal bypass and ileostomy were performed to prevent bowel obstruction, followed by systemic chemotherapy. MSI-high was diagnosed on examination of the biopsy specimen. Treatment was then changed to immunotherapy using pembrolizumab; after six courses, the tumor markers were decreased to within normal ranges, but the main tumor increased. Radiation therapy was then given for local control of the main tumor, after which CT showed that all of the tumor, including the main tumor, lymph node metastases, and the colo-duodenal fistula, had gradually shrunk. Follow-up upper gastrointestinal endoscopy showed that the colo-duodenal fistula had closed completely. PET-CT showed no abnormal uptake in all tumors, and clinical complete response was diagnosed. Now, 21 months after diagnosis, the tumor is well controlled without evidence of regrowth.
CONCLUSIONS
Pembrolizumab combined with radiation therapy has a potentially dramatic therapeutic effect for advanced colon cancer.
背景
结肠十二指肠瘘是结肠癌一种非常罕见的并发症，不仅伴有严重的临床症状，而且由于局部晚期癌症导致预后不良。一种新型的用于结肠癌患者的免疫检查点抑制剂具有较高的客观缓解率。最近，有报道称放射治疗联合免疫检查点抑制剂治疗具有协同抗肿瘤作用。本文报道了1例局部晚期结肠癌患者在接受帕博利珠单抗联合放射治疗后结肠十二指肠瘘完全闭合的病例。
病例介绍
一名66岁男性因腹胀就诊。腹部增强计算机断层扫描（CT）显示右上腹有一个80毫米的巨大肿块。肿瘤与十二指肠第二部形成瘘管。上消化道内镜检查显示结肠十二指肠瘘。进行了胃空肠吻合术和回肠造口术以预防肠梗阻，随后进行全身化疗。活检标本检查诊断为微卫星高度不稳定（MSI-high）。随后治疗改为使用帕博利珠单抗进行免疫治疗；六个疗程后，肿瘤标志物降至正常范围内，但主要肿瘤增大。然后给予放射治疗以局部控制主要肿瘤，之后CT显示所有肿瘤，包括主要肿瘤、淋巴结转移灶和结肠十二指肠瘘均逐渐缩小。随访上消化道内镜检查显示结肠十二指肠瘘已完全闭合。正电子发射断层扫描-CT（PET-CT）显示所有肿瘤均无异常摄取，诊断为临床完全缓解。目前，诊断后21个月，肿瘤得到良好控制，无复发迹象。
结论
帕博利珠单抗联合放射治疗对晚期结肠癌可能具有显著的治疗效果。
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