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肝肺寡转移结直肠癌的转移灶切除术与立体定向体部放疗:一名96岁患者完全缓解的病例报告

Metastasectomy and Stereotactic Body Radiotherapy for Colorectal Cancer With Liver and Lung Oligometastases: A Case Report of Complete Remission in a 96-Year-Old Patient.

作者信息

Pan Ming

机构信息

Radiation Oncology, Windsor Regional Hospital Cancer Program, Windsor, CAN.

出版信息

Cureus. 2024 Apr 12;16(4):e58135. doi: 10.7759/cureus.58135. eCollection 2024 Apr.

Abstract

We report a rare case of an extremely old colorectal cancer (CRC) patient who had complete remission after liver metastasectomy and stereotactic body radiotherapy (SBRT) to lung oligometastases (OM), with good quality of life and no evidence of recurrence 12 years after the initial diagnosis. An 83-year-old male patient had a right hemicolectomy for stage pT3 pN0 adenocarcinoma of the colon. Soon he was found to have liver metastasis treated with radiofrequency ablation and then liver metastasectomy with clear margins, followed by chemotherapy in the form of FOLFIRI for six months. Six years later, positron emission tomography (PET) showed 1.6 cm OM in the left upper lobe lung. He was not considered a good candidate for surgery. We offered him SBRT 48 Gy in four fractions every other day. The lesion disappeared with no recurrence in the same location on PET and serial computed tomography (CT) scans. Three years later, PET-CT found a new OM in the left lingular lung measuring 1.2 cm. A CT-guided lung biopsy confirmed invasive adenocarcinoma favoring OM from the CRC. SBRT planning failed due to its proximity to the heart. He accepted the longer course of conventional volumetric modulated arc therapy at 60 Gy in 15 fractions with daily cone-beam CT guidance. Again, he tolerated treatment very well with no significant side effects, despite his age. He did not require any chemotherapy or other systemic treatment in the last 11 years, so he did not experience any toxicities related to such treatment. This case is important to show that old age alone should not be considered a contraindication for metastasectomy and SBRT for CRC with liver and lung OM.

摘要

我们报告了一例极为罕见的老年结直肠癌(CRC)患者,该患者在肝转移灶切除及对肺寡转移灶(OM)进行立体定向体部放疗(SBRT)后实现了完全缓解,初诊12年后生活质量良好且无复发迹象。一名83岁男性患者因结肠pT3 pN0期腺癌接受了右半结肠切除术。不久后他被发现出现肝转移,先接受了射频消融治疗,随后进行了切缘阴性的肝转移灶切除术,接着接受了6个月的FOLFIRI方案化疗。6年后,正电子发射断层扫描(PET)显示左上肺有一个1.6 cm的寡转移灶。他被认为不适合手术。我们为他提供了隔日4次分割、总剂量48 Gy的SBRT治疗。该病灶消失,PET及系列计算机断层扫描(CT)扫描显示同一部位无复发。3年后,PET-CT发现左舌叶肺有一个新的1.2 cm寡转移灶。CT引导下的肺活检证实为侵袭性腺癌,倾向于结直肠癌的寡转移灶。由于该病灶靠近心脏,SBRT计划失败。他接受了在每日锥形束CT引导下、15次分割、总剂量60 Gy的较长疗程的常规容积调强弧形放疗。尽管年事已高,但他对治疗的耐受性依然很好,没有明显副作用。在过去11年里,他无需任何化疗或其他全身治疗,因此也未经历与这类治疗相关的任何毒性反应。该病例很重要,表明不应仅因患者年龄大就将其视为结直肠癌伴肝肺寡转移灶进行转移灶切除及SBRT的禁忌证。

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