光动力治疗晚期支气管肺癌并长期生存典型病例1例并文献复习  

Photodynamic Therapy for Advanced Bronchial Lung Cancer with Long-Term Survival in a Typical Case and Literature Review

作　　者：李雪燕 杨晓晖 丁晓倩 林存智 

机构地区：[1]青岛大学医学部,山东 青岛

出　　处：《临床医学进展》2024年第2期3313-3319,共7页Advances in Clinical Medicine

摘　　要：目的:探讨光动力疗法(PDT)治疗支气管肺癌的临床效果及安全性。方法:报道1例2020年7月确诊为晚期肺癌行放化疗联合免疫及光动力治疗,且在长达3年多的随访中未见远处转移患者的临床资料、诊疗经过。以“光动力疗法,肺癌”以及“photodynamic therapy,lung cancer”为检索词,在万方医学数据库及pubmed中进行文献检索。结果:患者男,68岁,因“咳嗽、咳痰6个月,间断痰中带血2个月”入院,既往吸烟史35年、饮酒史25年。入院后胸部CT动态增强示右肺上叶肺癌并阻塞性肺炎可能性大,行支气管镜检查发现右主支气管菜花样新生物生长,活检病理证实为鳞状细胞癌,免疫组化:PD-L1-22C3 (TPS < 1%),PET/CT检查未见远处转移。诊断为右肺恶性肿瘤(鳞癌T4N3M1,IV期)。患者于2020-08-15至2021-04-24分别行免疫 + TP化疗方案及放疗治疗,效果欠佳。由于出现呼吸困难症状,于2021-05-21行支气管病损切除 + 光动力治疗,症状明显改善并予以出院。后因为多次呼吸困难行支气管病损切除 + 光动力治疗。患者近期数次复查,见管腔通畅,肿瘤未见生长。在万方医学数据库中检索到19篇PDT及其联合治疗方法的疗效评估,7篇PDT治疗致肿瘤凋亡机制相关研究,3篇PDT中改良光敏剂效果评估。PubMed数据库检索到66篇,54篇PDT治疗致肿瘤凋亡机制相关研究,12篇新型光敏剂疗效评估。结论:光动力联合化疗或免疫治疗晚期支气管肿瘤有明显优势,可改善患者生存期,获得远期获益。Objective: To investigate the clinical efficacy and safety of photodynamic therapy (PDT) in the treatment of bronchial lung cancer. Methods: To report the clinical data, treatment and follow-up process of a patient who was diagnosed with advanced lung cancer and treated with photodynamic therapy in July 2020 and had no distant metastasis during the 3-year follow-up period. The search terms “photodynamic therapy, lung cancer” and “photodynamic therapy, lung cancer” were used to conduct literature searches in Wanfang Medical Database and Pubmed. Results: The patient was 65 years old and was admitted to the hospital with “coughing and sputum for 6 months, with blood in sputum intermittently for 2 months”, with a history of smoking for 35 years and drinking alcohol for 25 years. After admission, a CT with dynamic enhancement of the chest showed lung cancer in the upper lobe of the right lung with a high probability of obstructive pneumonia. Bronchoscopy re-vealed cauliflower-like neoplastic growths in the right main bronchus, and biopsy confirmed squa-mous cell carcinoma, immunohistochemistry: PD-L1-22C3 (TPS < 1%), MDM-2 (weak+). PET/CT did not show distant metastasis. The patient was diagnosed with a malignant tumor of the right lung (squamous carcinoma T4N3M1, stage IV). The patient was treated with immune + TP chemotherapy regimen and radiotherapy on 2020-08-15 and 2021-04-24, respectively, with unsatisfactory re-sults. Due to symptoms of dyspnoea, bronchial lesion resection + photodynamic therapy was per-formed on 2021-05-21, with significant improvement in symptoms and discharge. Later, he under-went bronchial lesion resection + photodynamic therapy because of repeated dyspnoea. The patient was reviewed several times recently and was seen to have a clear lumen and no growth of the tu-mour. In Wanfang Medical Database, 19 studies on the efficacy of PDT and its combination therapy were retrieved, 7 studies on the mechanism of apoptosis caused by PDT, and 3 studies on the effect of modified photosensit

关 键 词：光动力疗法 肺癌 支气管 个案报道 文献复习 

分 类 号：R73[医药卫生—肿瘤]