气管支架置入术后免疫治疗引起的气管食管瘘快速进展。

Biomedicine Hub Pub Date : 2019-07-25 eCollection Date: 2019-05-01 DOI:10.1159/000501157
Shinjiro Mizuguchi, Makoto Takahama, Ryu Nakajima, Hidetoshi Inoue, Ryuichi Ito, Ryoji Yamamoto
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引用次数: 3

摘要

气管食管瘘(TEF)的发展是食管癌或肺癌治疗的严重并发症,特别是放射治疗后。然而,TEF作为化疗或气管支架置入术术后并发症的发展是相当罕见的。我们在此报告一个罕见的病例,涉及晚期腺癌侵犯纵隔的患者,在放置气管支架和给予纳沃单抗免疫治疗后迅速发展为TEF。一个55岁的重度吸烟者被诊断为肺腺癌并纵隔侵犯。在一线治疗(化疗和放疗)9个月后,他接受了纳武单抗(3mg /kg)作为第四线治疗。第一次给药两周后,由于食管旁淋巴结肿大发展迅速,气管狭窄严重,患者行气管支架机械肿瘤减容术。2周后,他接受了第二剂纳武单抗;然而,第二次给药后12天的影像学检查显示,通过转移性淋巴结,上气管和食管之间有一个巨大的瘘管。由于瘘管扩张和窒息风险,没有考虑额外的支架或更换支架。尽管进一步治疗,患者2个月后死于原发疾病。我们的发现将引起读者的极大兴趣,特别是那些参与免疫治疗晚期肺癌患者临床治疗的读者。了解经壁气管转移/侵袭时TEF形成的潜在破坏性,将使临床医生能够为患者提供最好的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement.

Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement.

Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement.

Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement.

Development of a tracheoesophageal fistula (TEF) is a serious complication of treatment for esophageal or lung cancer, especially following radiation therapy. However, development of a TEF as a complication of chemotherapy or tracheal stenting after surgical debulking is quite uncommon. We herein report a rare case involving a patient with advanced adenocarcinoma invading the mediastinum who rapidly developed a TEF after placement of a tracheal stent and administration of nivolumab immunotherapy. A 55-year-old heavy ex-smoker was diagnosed with lung adenocarcinoma with mediastinal invasion. Nine months after first-line therapy (chemotherapy and radiation therapy), he underwent treatment with nivolumab (3 mg/kg) as fourth-line therapy. Two weeks after the first dose, he underwent mechanical debulking of the tumor with tracheal stenting because of the rapid development of paraesophageal lymph node swelling and severe tracheal stenosis. He received a second dose of nivolumab 2 weeks later; however, imaging studies 12 days after this second dose revealed a huge fistula between the upper trachea and esophagus through a metastatic lymph node. Neither an additional stent nor replacement of the stent was considered because of the fistula site expansion and suffocation risk. Despite further treatment, the patient died of his primary disease 2 months later. Our findings will be of great interest to the readers, especially those involved in the clinical treatment of patients with advanced lung cancer treated by immunotherapy. The knowledge of potentially devastating TEF formation in the presence of transmural tracheal metastasis/invasion will allow clinicians to provide the best possible care for their patients.

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