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題名 | Newly Developing Osteoblastic Lesions during Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Treatment Do Not Necessarily Indicate Disease Progression=成骨病兆出現在接受表皮生長因子接受體酪胺酸激酶抑制劑治療的非小細胞肺癌病患並非一定意謂疾病惡化 |
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作者 | 黃健裕; 陽光耀; 邱昭華; 蔡俊明; 李毓芹; | 書刊名 | 胸腔醫學 |
卷期 | 26:6 2011.12[民100.12] |
頁次 | 頁363-368 |
分類號 | 415.468 |
關鍵詞 | 成骨病兆; 表皮生長因子接受體酪胺酸激酶抑制劑; 非小細胞肺癌; Osteoblastic reaction; Epidermal growth factor receptor tyrosine kinase inhibitor; Non-small cell lung cancer; |
語文 | 英文(English) |
中文摘要 | 非小細胞肺癌病患在診斷當初甚至在疾病進展的過程常伴隨有骨骼轉移。影像學上骨骼轉移可以是蝕骨病兆,成骨病兆或兩者同時表現。當我們在判讀接受表皮生長因子接受體酪胺酸激酶抑制(EGFRTKI)治療的病患的治療反應時,在影像學上若出現成骨現象的反應時必須非常謹慎。因為對治療有反應的病人在影像學上亦可表現成骨病兆。我們報告三位接受EGFR-TKI的非小細胞肺癌病患,在追蹤的過程當中,除了骨頭出現成骨反應外,其疾病是處於有反應或穩定狀態。但放射學專家一開始都認為此成骨反應表現代表疾病惡化。當我們持續追蹤至少四個月後發現,這些疾病仍是處於穩定階段,甚至原發病兆有縮小。因此,當臨床醫師在判讀成骨反應的影像學之表現時,除了疾病惡化以外,鑑別診斷還必須包含這是有效的治療。 |
英文摘要 | Bone metastases commonly occur in patients with non-small cell lung cancer (NSCLC) at the time of diagnosis or during the disease course. Metastatic bone lesions can present radiographically as an osteolytic, osteoblastic, or mixed pattern. Osteoblastic bone lesions that present in patients during treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) must be interpreted with caution, and be differentiated as either the sign of a truly progressive disease or a repairing reaction caused by a good therapeutic response. Misinterpretation may lead to a contrary prognosis. Herein, we present 3 NSCLC patients who had increased or newly developing osteoblastic bone lesions after 3 months of EGFR-TKI treatment, but the primary tumors were otherwise responding or stable. All chest CT scans were interpreted as progressive disease by the radiologists, but the patients were kept on the same treatment based on clinical judgment. All 3 patients had disease control for at least 4 months afterward. Therefore, increased or newly developing osteoblastic bone lesions that appear during treatment with EGFR-TKI should be interpreted with caution, because they do not always indicate progressive disease. |
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