口服吉非替尼同步放疗致间质性肺炎1例

One case of interstitial pneumonia caused by oral gefitinib and radiotherapy

1例70岁肺癌(T3N0M0ⅡB期)患者,在口服吉非替尼(易瑞沙TM)43天后联合局部放疗,放疗剂量74Gy,32次,放疗结束后4天患者出现咳嗽,咳少量白色粘痰,痰液不易咳出,胸闷、憋气并进行性加重。CT显示:左肺见多发片状玻璃密度影,其内可见细网格状改变,左侧叶间胸膜增厚。X片显示:左肺门增大,增浓,周围可见斑片及索条状密度增高影,初诊间质性肺炎。停用吉非替尼,予吸氧、抗炎、激素、扩张支气管、营养支持等治疗,1个月后胸闷、憋气较前明显好转,X片和CT显示肺部炎症较治疗前明显吸收。

A 70-year-old man with lung carcinoma （T3N0M0 Ⅱ B staging） was administered gefitinib for 43 days and after this, he received local radiotherapy at equal pace. Total radiation dosage was 74Gy, 32 times. Four days later, the patient developed cough, a small quantity white phlegm that is difficult to expectorate, chest distress and breath holding that aggravated gradually after radiotherapy ended. CT showed more than scattered distribution of ground-glass density in the left lung that could see fine-mesh change. Lobus lateralis sinister had pleural thickening. X ray revealed hilum of left lung increased and concentrated and saw around spot higher-density and cable strip density video. Gefitinib was stopped considering interstitial pneumonia and he was given oxygen therapy, anti-inflammatory, hormone, bronchus dilation and nutritional support therapy. A month later, his chest distress and breath holding were relieved obviously than before. X ray and CT both showed that inflammation of lung was absorbed obviously than pretherapy.