小细胞肺癌合并慢性肾功能不全患者的治疗策略：1例报告

Treatment strategy for small cell lung cancer complicated with chronic renal failure: a case report

目的:探讨小细胞肺癌合并慢性肾功能不全患者的治疗策略。方法:回顾性分析1例小细胞肺癌合并慢性肾功能不全患者的病历资料及诊治过程,行多学科协作探讨其治疗策略。结果:本例小细胞肺癌合并严重肾功能不全的患者,经多学科讨论制定治疗方案:在平时腹膜透析的基础上,行减量依托泊苷联合铂类方案(etoposide plus platinum,EP)化疗,化疗前后增加血液透析;待化疗控制病情后,局部病灶行放射治疗。经过一线EP方案联合肺部病灶放疗后,患者的无进展生存时间为13个月。随后评估发现右肾上腺寡病灶转移,遂行局部放疗。目前已完成转移灶局部放疗以及全脑预防性放疗。在治疗过程中,患者不良反应基本可以耐受,表现为贫血、白细胞减少、恶心和食欲降低等。结论:针对小细胞肺癌合并肾功能不全的患者,要积极开展多学科讨论,实施安全有效的治疗。

Objective: To explore the treatment strategy of small cell lung cancer(SCLC) patients complicated with chronic renal failure.Methods: The medical records of a case of SCLC complicated with chronic renal failure were reviewed retrospectively. And the therapeutic strategy for SCLC complicated with chronic renal failure was explored by multi-disciplinary team(MDT).Results: For the SCLC patient complicated with chronic renal failure, the treatment plan was developed by MDT discussion. Based on the normal abdominal dialysis, the reduced dosage chemotherapy of etoposide combined with platinum(EP) was performed. Meanwhile, hemodialysis was added before and after chemotherapy. The local lesions controlled after chemotherapy were treated with radiotherapy. The progression-free survival time was 13 months after first-line EP chemotherapy combined with radiotherapy for pulmonary lesions. Subsequently, the right adrenal metastasis was diagnosed by enhanced magnetic resonance imaging of the upper abdomen. So the local radiotherapy for metastasis lesions was completed, and the whole brain prophylactic radiotherapy has been performed at present. In the course of treatment, the patient could tolerate adverse effects including anemia, leukopenia, nausea and decreased appetite.Conclusion: For SCLC patients complicated with renal failure, the MDT discussion should be actively carried out to implement a safe and effective treatment.