一例初诊ⅢC期肺上沟瘤肺鳞癌患者的MDT诊治报道  

MDT diagnosis and treatment of a stage ⅢC lung squamous cell carcinoma case presented as superior sulcus tumor

作　　者：王凯旋 简红[1] 罗清泉[1] 蔡旭伟[1] 吕长兴[1] 虞永峰[1] 赵继开[1] 江一峰[1] 廖美琳[1] 陆舜[1] 

机构地区：[1]上海交通大学附属胸科医院上海市肺部肿瘤临床医学中心,上海200030

出　　处：《实用肿瘤杂志》2018年第1期25-33,共9页Journal of Practical Oncology

基　　金：上海市卫生和计划生育委员会科研课题计划(201540365);上海市科学技术委员会科研计划项目(17431906103)

摘　　要：本文介绍1例ⅢC期肺上沟瘤肺鳞癌病例的多学科专家组(multidisciplinary team,MDT)诊治过程。患者,女性,初诊68岁,因右肩部疼痛伴右上肢握力下降1个月就诊。胸部CT提示右肺上叶肺上沟瘤。肺穿刺活检病理为低分化肺鳞癌,肿块侵犯临近肋骨、右锁骨下动脉、膈神经,伴右锁骨上淋巴结转移可疑,初治分期c-T4N3(可疑)M0,ⅢC期可能。第1次MDT讨论后,整体治疗方案拟行诱导治疗后手术切除,患者接受诱导化疗吉西他滨联合顺铂方案2个周期,右肺上叶肿块大小不变,右锁骨上肿大淋巴结缩小20%,总疗效为疾病稳定(stable disease,SD)。第2次MDT讨论,评估单纯诱导化疗肿瘤缩小不明显,及时改行同步放化疗诱导,同步化疗为依托泊苷联合顺铂方案2个周期;放疗部位右上肺肿块及右锁骨上转移淋巴结,剂量46 Gy/23 F,右肺上叶肿块缩小19%,内部大量坏死、空洞形成,右锁骨上肿大淋巴结缩小至≤1 cm,总疗效为部分缓解(partial response,PR);重分期yc-T4Nx M0,ⅢA期。第3次MDT讨论评估患者为同步放化疗后Nx患者,可从完整切除中显著获益,患者因糖尿病接受电视辅助胸腔镜右上叶肿块楔切合并右前胸L型切口右侧第一肋切除术及纵隔淋巴结采样术,术后分期ys-T4N0M0,ⅢA期。术后行辅助化疗吉西他滨联合卡铂方案2个周期。患者初诊至治疗结束共计7.5个月,后每3个月随访1次,未见肿瘤复发。目前,无进展生存期和总生存期均已>20个月。该诊治过程提示,对于Ⅲ期非小细胞肺癌肺上沟瘤患者,MDT诊治具有重要意义。This article describes the process of multidisciplinary team（ MDT） diagnosis and treatment of a stage ⅢC lung squamous cell carcinoma case presented as superior sulcus tumor. A 68-year old female arrived for the first visit with a chief complaint of right shoulder pain accompanied with decreased right upper limb grip for one month. Chest CT suggested superior sulcus tumor at the right upper lobe of the lung. The pathological test of lung biopsy showed poorly differentiated lung squamous cell carcinoma. The adjacent ribs,the right subclavian artery,and phrenic nerve were involved,with suspicious metastasis of the right supraclavicular lymph node. The initial staging was c-T4 N3（ suspicious） M0,stage ⅢC（ suspicious）. After the first MDT discussion,the treatment strategy was designed as induction therapy followed by resection. The patient received induction chemotherapy of gemcitabine combined with cisplatin for two cycles. The size of the right upper lobe tumor remained unchanged,but the right supraclavicular lymph node was reduced by 20%. The total effect was stable disease（ SD）. Subsequently,a second MDT discussion was conducted and concluded that the tumor reduction was insignificant by induction chemotherapy alone,and concurrent chemoradiotherapy is necessary. The patient was then switched to induction treatment of concurrent chemoradiotherapy,with two cycles of etoposide and cisplatin combined chemotherapy,together with radiotherapy which was given to the right upper lung mass and the right supraclavicular metastatic lymph node,with a dose of 46 Gy/23 fractions. After the chemoradiotherapy,the right upper lung tumor shrank 19%,with massive necrosis and empty formation. The right supraclavicular enlarged lymph node was reduced to less than 1 cm. The total effect was partial response（ PR）,re-staged as yc-T4 Nx M0,stage ⅢA. Afterwards,a third MDT discussion was organized and assessed the patient as Nx Pancoast tumor patient after concurrent chemoradiotherapy,who will be benefited signifi

关 键 词：肺肿瘤/外科学 肺肿瘤/病理学 肺肿瘤/放射疗法 癌 非小细胞肺/外科学 癌 非小细胞肺/诊断 体层摄影术 X线计算机 术前用药法 抗肿瘤联合化疗方案/治疗应用 顺铂/治疗应用 抗肿瘤药/治疗应用 脱氧胞苷/类似物和衍生物 脱氧胞苷/治疗应用 

分 类 号：R734.2[医药卫生—肿瘤]