1例HER2阳性胃癌肝肺转移患者的MDT治疗  

A case of HER2 positive gastric cancer with liver and lung metastases treated by a MDT team

作　　者：张敬南[1] 伍远航[1] 李浙民 周军[1] 李永恒[3] 刘毅强[4] 唐磊[5] 王雪娟[6] 郭宏杰[7] 方玉[8] 姜晗昉 李子禹[2] 张小田[1] 沈琳[1] 

机构地区：[1]北京大学肿瘤医院消化肿瘤内科,北京100142 [2]北京大学肿瘤医院胃肠肿瘤中心,北京100142 [3]北京大学肿瘤医院放疗科,北京100142 [4]北京大学肿瘤医院病理科,北京100142 [5]北京大学肿瘤医院影像科,北京100142 [6]北京大学肿瘤医院核医学科,北京100142 [7]北京大学第一医院血管外科,北京100034 [8]北京大学肿瘤医院营养科,北京100142 [9]北京大学肿瘤医院乳腺科,北京100142

出　　处：《实用肿瘤杂志》2016年第2期115-121,共7页Journal of Practical Oncology

摘　　要：本文介绍1例人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)过表达的胃腺癌同时性肝肺转移患者的多学科诊治过程。该患者初诊时病情危重,肿瘤负荷较大,存在深静脉血栓形成及上消化道出血等化疗禁忌证。经多学科讨论后,在积极处理合并疾病的基础上,谨慎给予化疗联合靶向药物治疗,患者肝肺转移灶明显缩小并长期控制;在此过程中,原发灶缓慢进展,是肿瘤异质性在临床实践中的典型案例,考虑到既往存在消化道出血病史,经多学科充分讨论衡量利弊后,切除原发灶,现以靶向药物维持治疗,疾病稳定,生活质量较高。该病例的诊治过程体现了多学科诊治在广泛转移的胃癌患者中仍然存在重要的价值,对于指导患者争取治疗时机,获得一线生机,改变预后结局,发挥着决定性的作用。A multidisciplinary team（ MDT） treatment of a HER2-positive gastric cancer patient with liver and lung metastases was described. At first present,the patient showed heavy tumor burden and critical symptoms,including chemotherapy contraindications,such as upper gastrointestinal bleeding and venous thrombus,and multiple metastases in liver and lung. After MDT discussion,we cautiously performed chemotherapy combined with drug targeted therapy to the patient,together with active treatments on her complications. The metastases in the liver and lung were reduced and remained stable,while the primary tumor still slowly progressed. Considering the patient＇s upper gastrointestinal bleeding history,we decided to resect the primary tumor,after another MDT discussion. Currently,the patient is under drug targeted maintenance treatment and her life quality was well. The treatment process of this case indicated that MDT was important for complicated gastric cancer with multiple metastases,and played a critical role in determining the optimal time window for surgery and improving prognosis.

关 键 词：胃肿瘤 药物疗法 外科学 放射疗法 肿瘤转移 受体 erbB-2 

分 类 号：R735.2[医药卫生—肿瘤]