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題 名 | Long-Term Survival after Induction Therapy Followed by Concurrent Target-Radiotherapy of an Unresectable Stage IIIB Non-Small Cell Lung Cancer Patient: Case Report=非小細胞肺癌第ⅢB期無法開刀患者接受前導性化療接續同步標靶放射治療之長期存活:病例報告 |
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作 者 | 蔡明宏; 吳銘芳; 劉文山; 吳子卿; 曾思文; | 書刊名 | 放射治療與腫瘤學 |
卷 期 | 21:1 2014.03[民103.03] |
頁 次 | 頁63-70 |
分類號 | 416.224 |
關鍵詞 | 非小細胞肺癌第三期B期無法開刀的病患; 前導性化學治療; 同步進行化學放射治療; Unresectable locally advanced NSCLC; Induction chemotherapy; Target-radiotherapy; |
語 文 | 英文(English) |
中文摘要 | 非小細胞肺癌第三期不能開刀者的三年存活率只有百分之八,目前治療的主流是同步進行化學放射治療(concurrent chemoradiotherapy)。至於是否加入前導性化學治療(induction chemotherapy)則未有定論。同步進行化學放射治療副作用大,因此病人必須有好的身體狀況與肺功能才適合進行,病患若對化學治療反應不好,即使加強局部放射治療,除了增加副作用外,也無法阻止遠處轉移的可能性而失去痊癒的機會。根據下咽喉癌治療的經驗,前導性化學治療的反應,可以預測接續的同步化學放射治療的預後。標靶藥物艾瑞莎(iressa)對東方人的獨特療效已反應在許多臨床試驗,長期使用的副作用也遠低於傳統化學治療藥物,在進行同步化學放射治療時也不須減量。在此我們報告一位cT43M0非小細胞肺癌第三期B期無法開刀的病患,在經過兩線前導性化學治療失敗後,接受口服艾瑞莎治療並且在胸部X光片檢查達到腫瘤全消的反應。病患在持續口服艾瑞莎的情況下接續同步放射治療,治療結束後正子攝影顯示腫瘤完全消失。整體無惡化存活期接近四年,無病存活期大約兩年,病患之後因腫瘤復發,合併吸入性肺炎於2011年死亡,但是此種治療方式大大延長病人的存活。我們認為非小細胞肺癌第三期B期不能開刀的病患應該先接受前導性化學治療,若腫瘤有變小,再接受同步化學放射治療,會有比較長的無病存活期甚至痊癒。 |
英文摘要 | Concurrent chemoradiotherapy (CCRT) is the standard therapy for patients with unresectable locally advanced non-small cell lung cancer (NSCLC). CCRT is usually associated with various levels of complications due to the dosage of either chemotherapy regimen or radiation; therefore, only patients with good performance status were qualified for this aggressive treatment. Gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), is well tolerated compared with most chemotherapy regimens in treating NSCLC patients, and there is no need to decrease the dosage of gefitinib when combined with radiotherapy. Induction chemotherapy, although not recommended in the treatment strategy for patients with unresectable NSCLC, may be appropriate for select patients who are most likely to benefit from subsequent CCRT. In this case, we report on an unresectable stage IIIB NSCLC patient, who had failed to two lines of chemotherapy, received gefitinib followed by concurrent target-radiotherapy with complete remission and long-term disease free survival for 2 years. We suggest that patients with unresectable NSCLC should be initially considered to receive induction chemotherapy or target therapy and plan further treatment such as radiotherapy or surgery according to the response. |
本系統中英文摘要資訊取自各篇刊載內容。