中药联合125I粒子植入术及靶向治疗晚期肺腺癌1例及文献复习  

Chinese medicine plus 125I seed implantation and targeted therapy in the treatment of advanced lung adenocarcinoma:one case report and literature review

作　　者：赵于钧 吕清国[2] ZHAO Yujun

机构地区：[1]长春中医药大学,吉林长春130117 [2]长春中医药大学附属医院,吉林长春130021

出　　处：《中医临床研究》2024年第32期82-86,共5页Clinical Journal Of Chinese Medicine

基　　金：吉林省中医药管理局科研计划项目(2023034)。

摘　　要：文章介绍1例接受联合治疗的晚期肺腺癌病例及文献复习。患者为女性,65岁,确诊为肺腺癌晚期,伴有重度消瘦(身体质量指数:12.5kg/m2)和纵隔淋巴结、骨等多处转移。患者曾接受粒子植入术及盲用分子靶向药物吉非替尼治疗,治疗初期肺内病灶稳定,但15个月后肺内复发进展并出现远端转移,血液基因学检测结果显示存在表皮生长因子受体外显子19缺失突变(E19del)、T790M阴性。由于患者无法耐受传统化学治疗,遂继续使用分子靶向药物,同时联合中药和粒子植入术进行治疗,经过4个月的联合治疗,胸部CT显示肺内病灶较之前缩小,评估影像学结果,根据RECIST 1.1评价考虑病情稳定。这表明中药联合粒子植入术及靶向药物治疗能够延长患者的无进展生存期,并降低局部复发率。同时,中药在减轻靶向治疗和放疗所引起的不良反应和改善患者临床症状方面发挥了独特的作用。文献复习表明,中药复方制剂能通过调节免疫活性、抑制免疫逃逸改善机体免疫状态,在延长晚期肺癌患者病情稳定期和提高生活质量方面具有显著优势。此案例的治疗经验进一步支持了中药联合其他治疗方法在晚期肺腺癌治疗中的有效性,为临床治疗提供参考。This article presents one case of advanced lung adenocarcinoma treated by a combination therapy and includes a literature review.The patient is a 65-year-old female diagnosed with advanced lung adenocarcinoma,accompanied by severe emaciation(body mass index is 12.5 kg/m²)and multiple metastases to mediastinal lymph nodes and bones.The patient had received particle implantation and empirical treatment with the molecular targeted drug gefitinib.Initially,the lung lesions were stable,but 15 months later,the recur and progress in the lungs and distant metastasis occurred.Blood genetic testing revealed an epidermal growth factor receptor exon 19 deletion mutation(E19 del)and negative T790M.Because the patient could not tolerate conventional chemotherapy,molecular targeted drugs were continued to be used,accompanied by Chinese medicine plus particle implantation.After four months of combination therapy,chest CT showed that the lung lesions had reduced in size.The imaging results were evaluated,and the disease was considered as stable according to RECIST 1.1 evaluation results.This case demonstrates that Chinese medicine plus particle implantation and targeted drugs can prolong the progression-free survival of patients and reduce the local recurrence rate.Additionally,Chinese medicines have played a unique role in mitigating adverse reactions due to targeted therapy and radiotherapy and ameliorating the clinical symptoms of patients.The literature review indicates that Chinese medicine compound preparations can ameliorate the immune status of the body by modulating immune activity and inhibiting immune escape,providing significant advantages in prolonging the stable period of disease and improving the quality of life of advanced lung cancer patients.The treatment experience of this case further supports the effectiveness of Chinese medicines plus other therapies in the treatment of advanced lung adenocarcinoma,offering insights for clinical practice.

关 键 词：中药 晚期肺腺癌 粒子植入术 分子靶向药 

分 类 号：R273[医药卫生—中西医结合]