Huang Jie, Chen Xueqin
Department of Thoracic Oncology, Hangzhou Cancer Hospital, No. 34, Yanguan Lane, Shangcheng District, Hangzhou 310002, China.
Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou 310006, China.
Diagnostics (Basel). 2025 May 18;15(10):1280. doi: 10.3390/diagnostics15101280.
Tumor cavitation is distinguished by the emergence of central necrosis and cavity formation within the tumor mass, which indicates a notable outcome of anti-angiogenic therapies. This case describes a 52-year-old Chinese female with advanced EGFR-mutated lung adenocarcinoma (Exon 19 deletion), which was metastatic to bilateral lungs, brain, and right adrenal gland, who exhibited a radiographic response to combination therapy with the third-generation EGFR tyrosine kinase inhibitor (TKI) aumolertinib and the anti-angiogenic agent anlotinib. The patient achieved near-complete cavitation of almost all bilateral lung nodules, manifesting as distinctive "bullet hole" lesions on the chest CT. Despite this initial response, disease progression occurred two months later with new liver metastases, culminating in the patient's death. This case underscores the potential efficacy of EGFR TKIs and anti-angiogenic agents in inducing unique tumor microenvironment modifications, while highlighting the transient nature of such responses and the critical need to address resistance mechanisms. Tumor cavitation may serve as a radiographic marker of anti-angiogenic activity but does not preclude metastatic spread, necessitating vigilant monitoring even in the setting of favorable imaging changes.
肿瘤空洞形成的特征是肿瘤块内出现中央坏死和空洞形成，这表明抗血管生成治疗取得了显著成效。本病例描述了一名52岁的中国女性，患有晚期表皮生长因子受体（EGFR）突变的肺腺癌（外显子19缺失），已转移至双侧肺、脑和右肾上腺，她对第三代EGFR酪氨酸激酶抑制剂（TKI）奥莫替尼和抗血管生成药物安罗替尼的联合治疗表现出影像学反应。患者几乎所有双侧肺结节都实现了近乎完全的空洞形成，在胸部CT上表现为独特的“弹孔”病变。尽管有这一初始反应，但两个月后疾病进展并出现了新的肝转移，最终导致患者死亡。该病例强调了EGFR TKIs和抗血管生成药物在诱导独特的肿瘤微环境改变方面的潜在疗效，同时突出了这种反应的短暂性以及应对耐药机制的迫切需求。肿瘤空洞形成可能作为抗血管生成活性的影像学标志物，但并不能排除转移扩散，即使在影像学改变良好的情况下也需要进行密切监测。
