放疗联合吉非替尼治疗EGFR敏感突变低级别肺黏液表皮样癌1例报告及文献复习

doi:10.13481/j.1671-587x.20190641

吉林大学学报(医学版) ›› 2019, Vol. 45 ›› Issue (06): 1436-1439.doi: 10.13481/j.1671-587x.20190641

放疗联合吉非替尼治疗EGFR敏感突变低级别肺黏液表皮样癌1例报告及文献复习

历程¹, 刘慧¹, 郭亮², 马云飞¹, 刘百龙¹, 董丽华¹

1. 吉林大学第一医院放疗科, 吉林长春 130021;
2. 吉林大学第一医院病理科, 吉林长春 130021

收稿日期:2019-04-01 出版日期:2019-12-05 发布日期:2019-12-05
通讯作者: 刘百龙,副主任医师,硕士研究生导师(Tel:0431-88783742,E-mail:bailong3385@163.com);董丽华,教授,博士研究生导师(Tel:0431-88782468,E-mail:drlhdong@163.com) E-mail:bailong3385@163.com;drlhdong@163.com
作者简介:历程(1993-),男,吉林省延吉市人,在读医学硕士,主要从事胸部恶性肿瘤放射治疗方面的研究。
基金资助:
国家自然科学基金资助课题（81773353）

Radiotherapy combined with gefitinib in treatment of low-grade pulmonary mucoepidermoid carcinoma with EGFR sensitive mutation: A case report and literature review

LI Cheng¹, LIU Hui¹, GUO Liang², MA Yunfei¹, LIU Bailong¹, DONG Lihua¹

1. Department of Radiation Oncology, First Hospital, Jilin University, Changchun 130021, China;
2. Department of Pathology, First Hospital, Jilin University, Changchun 130021, China

Received:2019-04-01 Online:2019-12-05 Published:2019-12-05

摘要/Abstract

摘要： 目的：探讨局部放射疗法（放疗）联合表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKIs）治疗无法手术切除、EGFR敏感突变低级别肺黏液表皮样癌（PMEC）患者的疗效，分析该治疗模式的有效性和安全性，为其临床治疗提供参考。方法：收集1例明确诊断为PMEC患者的临床资料，结合相关文献，分析患者影像学和临床症状的变化与预后的关系。结果：患者，女性，22岁，因胸闷气短、干咳2个月入院。病理诊断为PMEC，基因检测示EGFR基因21号外显子L858R突变，无法手术切除。患者入院后给予吉非替尼250 mg·d^-1口服，同步局部放疗2 Gy/次，25次，共50 Gy。经局部放疗联合口服吉非替尼治疗后，患者病灶较放疗前缩小，持续口服吉非替尼至今，病灶进一步缩小；患者除皮疹外无不良反应，无进展生存期（PFS）已达18个月。结论：对于EGFR敏感突变、不可手术切除的低级别PMEC，放疗联合EGFR-TKIs的治疗模式疗效较好，不良反应可以接受。

关键词: 肺黏液表皮样癌, 表皮生长因子受体, 突变, 吉非替尼, 放射治疗, 酪氨酸激酶抑制剂

Abstract: Objective: To explore the curative effect of local radiotherapy combined with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in the treatment of the patient with unresectable and low-grade pulmonary mucoepidermal carcinoma (PMEC) with positive EGFR mutation, to analyze the effectiveness and safety of the treatment mode, and to provide the clinical reference for the treatment of this disease. Methods: The clinical data of a patient who diagnosed as PMEC was collected. The relationships between the changes of imaging and clinical symptoms and the prognosis of the patient were analyzed and the relative literatures were reviewed. Results: A 22-year-old woman was admitted to the hospital due to shortness of breath and 2 months of cough.The pathological diagnosis was PMEC,the L858R mutation in exon 21 of EGFR gene was found by gene detection and the tumor could not be resected by surgery.The patient was treated with gefitinib 250 mg·d^-1 orally combined with radiotherapy,and the dose of radiotherapy was 50 Gy totally with 2 Gy per fraction(25 times). After the treatment of local radiotherapy combined with oral administration of gefitinib, the tumor size was shrunk compared with before radiotherapy. The tumor size was shrunk further after the intervention of continuous oral gefitinib;the patient had no adverse reactions except the mild skin rash,and the progression free survival (PFS) was 18 months. Conclusion: For the unresectable and low-grade PMEC patient with positive EGFR mutation, the treatment mode of radiotherapy combined with EGFR-TKIs has good efficacy and the side effects could be accepted.

Key words: pulmonary mucoepidermal carcinoma, epidermal growth factor receptor, mutation, gefitinib, radiotherapy, tyrosine kinse inhibitors

中图分类号:

R734.2

历程, 刘慧, 郭亮, 马云飞, 刘百龙, 董丽华. 放疗联合吉非替尼治疗EGFR敏感突变低级别肺黏液表皮样癌1例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(06): 1436-1439.

LI Cheng, LIU Hui, GUO Liang, MA Yunfei, LIU Bailong, DONG Lihua. Radiotherapy combined with gefitinib in treatment of low-grade pulmonary mucoepidermoid carcinoma with EGFR sensitive mutation: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(06): 1436-1439.

参考文献

[1] HAN S W, KIM H P, JEON Y K, et al. Mucoepidermoid carcinoma of lung: potential target of EGFR-directed treatment [J]. Lung Cancer,2008, 61(1):30-34.
[2] YOUSEM S A, HOCHHOLZER L. Mucoepidermoid tumors of the lung [J]. Cancer,1987, 60(6):1346-1352.
[3] HUO Z, WU H, LI J, et al. Primary pulmonary mucoepidermoid carcinoma: histopathological and moleculargenetic studies of 26 cases [J]. PLoS One, 2015, 10(11):e0143169.
[4] ALSIDAWI S, MORRIS J C, WIKENHEISER-BROKAMP K A, et al. Mucoepidermoid carcinoma of the lung: a case report and literature review[J]. Case Rep Oncol Med, 2013,2013:625243.
[5] MOLINA J R, AUBRY M C, LEWIS J E, et al. Primary salivary gland-type lung cancer: spectrum of clinical presentation, histopathologic and prognostic factors[J]. Cancer,2007,110(10):2253-2259.
[6] XI JJ, JIANG W, LU S H, et al. Primary pulmonary mucoepidermoid carcinoma: an analysis of 21 cases[J]. World J Surg Oncol,2012,1:10:232.
[7] OMESH T, GUPTA R, SAQI A, et al. A rare case of endobronchial mucoepidermoid carcinoma of the lung presenting as non-resolving pneumonia[J]. Respir MedCaseRep,2018,25:154-157.
[8] SMETANA H F, IVERSON L, SWAN L L. Bronchogenic carcinoma; an analysis of 100 autopsy cases[J]. Mil Surg,1952,111(5):335-351.
[9] VASASZ P, EGERVRY M. Mucoepidermoid bronchial tumors: a review of 34 operated cases[J]. Eur J Cardiothorac Surg,2000,17(5):566-569.
[10] CURRAN W J, PAULUS R. Sequential vs. concurrent chemoradiation for stage Ⅲ non-small cell lung cancer: randomized phase Ⅲ trial RTOG 9410[J]. J NatlCancerInst,2011,103(19):1452-1460.
[11] EL M F, BEN S I, ISMALL O, et al. Mucoepidermoid carcinoma of the lung. A series of 10 cases [J]. Rev Pneumol Clin, 2005,61(2):78-82.
[12] MITSUDOMI T, MORITA S, YATABE Y, et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial[J]. Lancet Oncol, 2010,11(2):121-128.
[13] CHINNAIYAN P, HUANG S, VALLABHANENI G, et al. Mechanisms of enhanced radiation response following epidermal growth factor receptor signaling inhibition by erlotinib (Tarceva)[J]. Cancer Res,2005,65(8):3328-3335.
[14] JIANG T, MIN W, LI Y, et al. Radiotherapy plus EGFR TKIs in non-small cell lung cancer patients with brain metastases: an update meta-analysis[J]. Cancer Med, 2016,5(6):1055-1065.
[15] WANG J, XIA T Y, WANG Y J, et al. Prospective study of epidermal growth factor receptor tyrosine kinase inhibitors concurrent with individualized radiotherapy for patients with locally advanced or metastatic non-small-cell lung cancer[J].Int J Radiat Oncol Biol Phys, 2011,81(3):e59-65.
[16] OKAAMOTO I, TAKAHASHI T, OKAMOTO H, et al. Single-agent gefitinib with concurrent radiotherapy for locally advanced non-small cell lung cancer harboring mutations of the epidermal growth factor receptor[J].Lung Cancer, 2011,72(2):199-204.
[17] MOSCHINI I, DELL A C, LOSARDO P L, et al. Radiotherapy of non-small-cell lung cancer in the era of EGFR gene mutations and EGF receptor tyrosine kinase inhibitors[J]. Future Oncol, 2015,11(16):2329-2342.
[18] WANG Y, LI Y, XIA L, et al. Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment[J]. Clin Transl Oncol,2018,20(3):366-373.
[19] ZHUANG H, YUAN Z, CHANG J Y,et al. Radiation pneumonitis in patients with non-small-cell lung cancer treated with erlotinib concurrent with thoracic radiotherapy[J]. J Thorac Oncol, 2014,9(6):882-885.

放疗联合吉非替尼治疗EGFR敏感突变低级别肺黏液表皮样癌1例报告及文献复习

Radiotherapy combined with gefitinib in treatment of low-grade pulmonary mucoepidermoid carcinoma with EGFR sensitive mutation: A case report and literature review

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