内容紹介
Summary
We successfully treated a mechanically ventilated patient with severe respiratory failure caused by airway stenosis; she recovered after radiotherapy and gefitinib administration. A 68-year-old female with a pulmonary adenocarcinoma underwent a radical operation(right middle-lower sleeve lobectomy and lymph node dissection). Forty-four months later, she was admitted to our hospital with severe dyspnea, and was placed on mechanical ventilation after tracheal intubation. Postoperative cancer recurrence was evident in the bronchial mucosa and the site of carinal stenosis. Pathological examination revealed an epidermal growth factor receptor-positive adenocarcinoma. After radiotherapy(a total of 30 Gy), gefitinib(250 mg/day)was commenced. Respiratory function improved gradually, and ventilator weaning was successful 3 weeks after tracheal intubation. Computed tomography revealed a partial response; her recovery from the emergency oncological situation was remarkable. She was discharged 4 months after hospitalization. Although she took gefitinib every 2-to-7 days, she refused all examinations and possible treatments for 25 months after recurrence. Finally, she died of respiratory failure 29 months after recurrence and 73 months after the initial operation.
要旨
症例は72歳,女性。原発性肺腺癌根治術後(pT3N1M0,Stage ⅢA)外来フォロー中,術後3年8か月に呼吸困難が出現した。CTで気管分岐部の狭窄を認め,気管支鏡下生検にて腺癌再発と診断した(Ex21 L858R陽性)。その後急激に呼吸困難が増悪し,人工呼吸器管理となった。気管切開後,狭窄部位に対して放射線治療後にゲフィチニブの投与を開始した。治療開始後20日目に人工呼吸器を離脱し,4か月後に退院した。 以後ゲフィチニブを隔日～7日ごとに投与調整しつつ外来フォローとなり,再発治療後2年5か月に死亡した。癌緊急症を呈した肺癌の予後は不良であることが多く,本症例のように集学的治療により外来加療に移行できる症例は少なく,貴重な症例と思われたため文献的考察を加えて報告する。
目次
We successfully treated a mechanically ventilated patient with severe respiratory failure caused by airway stenosis; she recovered after radiotherapy and gefitinib administration. A 68-year-old female with a pulmonary adenocarcinoma underwent a radical operation(right middle-lower sleeve lobectomy and lymph node dissection). Forty-four months later, she was admitted to our hospital with severe dyspnea, and was placed on mechanical ventilation after tracheal intubation. Postoperative cancer recurrence was evident in the bronchial mucosa and the site of carinal stenosis. Pathological examination revealed an epidermal growth factor receptor-positive adenocarcinoma. After radiotherapy(a total of 30 Gy), gefitinib(250 mg/day)was commenced. Respiratory function improved gradually, and ventilator weaning was successful 3 weeks after tracheal intubation. Computed tomography revealed a partial response; her recovery from the emergency oncological situation was remarkable. She was discharged 4 months after hospitalization. Although she took gefitinib every 2-to-7 days, she refused all examinations and possible treatments for 25 months after recurrence. Finally, she died of respiratory failure 29 months after recurrence and 73 months after the initial operation.
要旨
症例は72歳,女性。原発性肺腺癌根治術後(pT3N1M0,Stage ⅢA)外来フォロー中,術後3年8か月に呼吸困難が出現した。CTで気管分岐部の狭窄を認め,気管支鏡下生検にて腺癌再発と診断した(Ex21 L858R陽性)。その後急激に呼吸困難が増悪し,人工呼吸器管理となった。気管切開後,狭窄部位に対して放射線治療後にゲフィチニブの投与を開始した。治療開始後20日目に人工呼吸器を離脱し,4か月後に退院した。 以後ゲフィチニブを隔日～7日ごとに投与調整しつつ外来フォローとなり,再発治療後2年5か月に死亡した。癌緊急症を呈した肺癌の予後は不良であることが多く,本症例のように集学的治療により外来加療に移行できる症例は少なく,貴重な症例と思われたため文献的考察を加えて報告する。