食管癌纵隔淋巴结转移射波刀治疗及泌尿系免疫不良反应诊治1例  

Mediastinal Lymph Node Metastasis and Immune-related Adverse Reactions after Cyberknife Surgery for Advanced Esophageal Cancer:A Case Report and Literature Review

作　　者：高雅 杜铭铭 肖燕 刘一博 王颖熠 张嘉诚 张海鸽 GAO Ya;DU Mingming;XIAO Yan;LIU Yibo;WANG Yingyi;ZHANG Jiacheng;ZHANG Haige(The First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang,China,471003)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院,中国洛阳471003

出　　处：《食管疾病》2024年第4期295-300,共6页Journal of Esophageal Diseases

摘　　要：食管癌是我国高发恶性肿瘤。因淋巴结清除受限与隐匿的微小转移等原因,仍有部分患者术后出现复发与转移。本文报道了1例合并纵隔淋巴结转移的晚期食管癌患者的射波刀治疗方式及接受长疗程免疫治疗后出现泌尿系症状的诊治。该患者术后定期复查发现纵隔淋巴结较前进展,既往曾行纵隔转移淋巴结螺旋断层放射治疗系统(TOMOTHERAPY,TOMO)调强放疗,评估淋巴结复发并逐渐增大后再次给予纵隔淋巴结射波刀放疗。经长疗程免疫治疗后患者尿白细胞明显增多,但尿培养和细胞学检查均为阴性。泌尿系免疫不良反应少,虽有报道但无明确诊断标准,经多学科会诊(MULTI-DISCIPLINARY TEAM,MDT)及文献检索后,患者被诊断为免疫性膀胱炎。本文回顾了食管癌纵隔淋巴结转移放疗的病例,以阐明其临床特征,尤其是射波刀为食管癌合并纵隔淋巴结转移者提供了安全有效的治疗手段,同时也为免疫性膀胱炎的临床早诊断、早治疗提供了有益的帮助。Esophageal cancer is a highly prevalent malignant tumor in China,characterized by limited lymph node dissection and occult micrometastasis,which often result in post-surgical recurrence and metastasis.This article presents the diagnosis and treatment of a patient with genitourinary symptoms following Cyberknife treatment and long-term immunotherapy for advanced esophageal cancer with mediastinal lymph node metastasis.The patient had previously undergone TOMO and IMRT for mediastinal lymph-node metastases.After evaluating the recurrence and progressive enlargement of the lymph nodes,re-treatment was performed using Cyberknife radiotherapy.Subsequently,long-term immunotherapy led to a significant increase in white blood cells on urine routine analysis,while urine culture and cytology were negative.Immune adverse reactions in the urinary system are rarely reported,lacking clear diagnostic criteria.Following multidisciplinary consultation(MDT)and literature review,immune cystitis was diagnosed in this patient.This article reviews cases of mediastinal lymph node metastasis in esophageal cancer to elucidate its clinical characteristics,particularly highlighting the safe and effective role of Cyberknife as a treatment modality for esophageal cancer with mediastinal lymph node metastasis.Additionally,it provides valuable insi-ghts into early diagnosis and management of immune cystitis.

关 键 词：食管癌 免疫相关不良反应 免疫性膀胱炎 纵隔淋巴结转移 射波刀 

分 类 号：R735.1[医药卫生—肿瘤]