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題 名 | A Patient with Lung and Pancreatic Adenocarcinomas Successfully Treated with Gefitinib and Distal Pancreatectomy after Feckless Chemotherapy=第一線及第二線化學治療失敗後改以Gefitinib治療肺腺癌並於胰臟病灶處施予放射化學治療之後以手術成功切除胰臟癌 |
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作 者 | 陳美如; 邱韋欽; 張士文; 何錄滄; 蔡崇弘; 蔡仲明; | 書刊名 | 臺灣外科醫學會雜誌 |
卷 期 | 42:2 2009.03-04[民98.03-04] |
頁 次 | 頁106-112 |
分類號 | 416.224 |
關鍵詞 | 肺腺癌; 腫瘤切除; 胰臟癌; 放射化學治療; Adenocarcinoma of unknown primary; Pancreatic cancer; Lung cancer; Tumor downsizing; Gefitinib; Thyroid transcription factor-1; |
語 文 | 英文(English) |
中文摘要 | 依行政院衛生署統計,肺癌爲台灣2006年腫瘤死因第一位,胰臟癌居第八位。外科切除提供胰臟癌根治機會,但診斷時僅15%~20%患者有幸完全切除。Gefitinib是epidermal growth factor receptor tyrosine kinase inhibitor,研究顯示出生東亞,女性,及不抽菸者,反應較好,臨床用於肺癌、乳癌、及胃癌…等治療。我們報告一72歲台灣男性,患者咳嗽及咳血兩週,體重減輕,2005年5月胸部X光及電腦斷層顯示右上肺野有一病灶,合併胰臟尾部6公分腫瘤,2005年6月安排電腦斷層指引肺部切片,病理報告爲腺癌,臨床依影像學診斷爲第三期肺癌及胰臟癌,經第一線及第二線化學治療,病灶仍擴大,自2005年12月改爲口服gefitinib,服藥兩週後肺部病灶幾乎消失,因此肺部除診斷切片外並未接受任何手術;持續15個月gefitinib治療及對胰臟病灶施予放射化學治療療程四個月後,胰臟病灶明顯改善,於2007年3月行遠端胰臟切除、脾臟、與胃部份切除;術中由於橫結腸界限不清,無法確定未被侵犯,故施行橫結腸部份切除。比較術前肺部電腦斷層指引切片和術後胃及胰臟標本,病理科醫師認爲其型態學及thyroid transcription factor-1(TTF-1)免疫染色表現兩者有所差異,病理診斷傾向double primary adenocarcinomas。截至2008年08月的影像追蹤,肺部及胰臟沒有復發及轉移現象,治療成功。 |
英文摘要 | Lung cancer was the most common cause of cancer death in Taiwan in 2006, and about 30 to 40 percent of lung cancer cases have adenocarcinoma. Surgical resection is preferred for patients with stage I non-small cell lung cancer, but for patients with stage Ⅲb, the options for treatment are diverse. Pancreatic cancer was the eighth largest cause of cancer death in Taiwan in 2006, and surgical resection is the only curative chance. However, only about 15 to 20 percent of pancreatic cancer patients can undergo curative resection. Gefitinib (Iressa®) is a quinazoline derivative, which is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor and is clinically used for patients with solid tumors, including non-small cell lung cancer. We examined a 72-year-old Taiwanese man with adenocarcinoma of unknown primary, including lung adenocarcinoma, cT4N3M0, stage Ⅲb, and pancreatic adenocarcinoma with stomach invasion, cT4N1M0, stage III at initial diagnosis on May 24, 2005. After treatment with gefitinib for his lung cancer and concurrent chemoradiotherapy (CCRT) for his pancreatic cancer, he underwent successful surgical procedures including distal pancreatectomy, splenectomy, gastric wedge resection and segmental resection of the transverse colon. The final pathologic diagnosis was pancreatic tail cancer, ductal adenocarcinoma with stomach invasion, ypT3N0M0, stage IIa. Seventeen months after the operation, no residual lung or pancreatic tumor was noted. Double primary cancers of the lung and pancreatic adenocarcinoma were favored by the pathologist because of the morphologic findings and the immunohistochemical staining of thyroid transcription factor-1 (TTF-1), which is specific to lung adenocarcinoma. Gefitinib treatment in this case probably contributed to the remission of non-small cell lung cancer, and allowed complete resection of pancreatic cancer after CCRT. |
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