光动力治疗晚期支气管肺癌并长期生存典型病例1例并文献复习

Photodynamic Therapy for Advanced Bronchial Lung Cancer with Long-Term Survival in a Typical Case and Literature Review

目的:探讨光动力疗法(PDT)治疗支气管肺癌的临床效果及安全性。方法:报道1例2020年7月确诊为晚期肺癌行放化疗联合免疫及光动力治疗,且在长达3年多的随访中未见远处转移患者的临床资料、诊疗经过。以“光动力疗法,肺癌”以及“photodynamic therapy,lung cancer”为检索词,在万方医学数据库及pubmed中进行文献检索。结果:患者男,68岁,因“咳嗽、咳痰6个月,间断痰中带血2个月”入院,既往吸烟史35年、饮酒史25年。入院后胸部CT动态增强示右肺上叶肺癌并阻塞性肺炎可能性大,行支气管镜检查发现右主支气管菜花样新生物生长,活检病理证实为鳞状细胞癌,免疫组化:PD-L1-22C3 (TPS < 1%),PET/CT检查未见远处转移。诊断为右肺恶性肿瘤(鳞癌T4N3M1,IV期)。患者于2020-08-15至2021-04-24分别行免疫 + TP化疗方案及放疗治疗,效果欠佳。由于出现呼吸困难症状,于2021-05-21行支气管病损切除 + 光动力治疗,症状明显改善并予以出院。后因为多次呼吸困难行支气管病损切除 + 光动力治疗。患者近期数次复查,见管腔通畅,肿瘤未见生长。在万方医学数据库中检索到19篇PDT及其联合治疗方法的疗效评估,7篇PDT治疗致肿瘤凋亡机制相关研究,3篇PDT中改良光敏剂效果评估。PubMed数据库检索到66篇,54篇PDT治疗致肿瘤凋亡机制相关研究,12篇新型光敏剂疗效评估。结论:光动力联合化疗或免疫治疗晚期支气管肿瘤有明显优势,可改善患者生存期,获得远期获益。

Objective: To investigate the clinical efficacy and safety of photodynamic therapy (PDT) in the treatment of bronchial lung cancer. Methods: To report the clinical data, treatment and follow-up process of a patient who was diagnosed with advanced lung cancer and treated with photodynamic therapy in July 2020 and had no distant metastasis during the 3-year follow-up period. The search terms “photodynamic therapy, lung cancer” and “photodynamic therapy, lung cancer” were used to conduct literature searches in Wanfang Medical Database and Pubmed. Results: The patient was 65 years old and was admitted to the hospital with “coughing and sputum for 6 months, with blood in sputum intermittently for 2 months”, with a history of smoking for 35 years and drinking alcohol for 25 years. After admission, a CT with dynamic enhancement of the chest showed lung cancer in the upper lobe of the right lung with a high probability of obstructive pneumonia. Bronchoscopy re-vealed cauliflower-like neoplastic growths in the right main bronchus, and biopsy confirmed squa-mous cell carcinoma, immunohistochemistry: PD-L1-22C3 (TPS < 1%), MDM-2 (weak+). PET/CT did not show distant metastasis. The patient was diagnosed with a malignant tumor of the right lung (squamous carcinoma T4N3M1, stage IV). The patient was treated with immune + TP chemotherapy regimen and radiotherapy on 2020-08-15 and 2021-04-24, respectively, with unsatisfactory re-sults. Due to symptoms of dyspnoea, bronchial lesion resection + photodynamic therapy was per-formed on 2021-05-21, with significant improvement in symptoms and discharge. Later, he under-went bronchial lesion resection + photodynamic therapy because of repeated dyspnoea. The patient was reviewed several times recently and was seen to have a clear lumen and no growth of the tu-mour. In Wanfang Medical Database, 19 studies on the efficacy of PDT and its combination therapy were retrieved, 7 studies on the mechanism of apoptosis caused by PDT, and 3 studies on the effect of modified photosensitisers in PDT. 66 studies were retrieved from PubMed database, 54 studies on the mechanism of apoptosis caused by PDT, and 12 studies on the efficacy of novel photosensi-tisers. Conclusion: Photodynamic combined with chemotherapy or immunotherapy for advanced bronchial tumours has obvious advantages, which can improve patient survival and gain long-term benefits.