Umdlavuza wamaphaphu omncane we-Metastatic-01

NgoJuni 2022, isiguli sowesilisa esineminyaka engu-65 ubudala sahlolwa ngokomzimba, futhi i-CT scan yembula i-nodule ngaphansi kwe-pleura engxenyeni engenhla yephaphu. NgoJanuwari 2023, isiguli saqala ukuba nezimpawu ezinjengokuhosha, ukukhwehlela, nokuphelelwa umoya. NgoMeyi 2023, ukukhwehlela kwakhe kanye nokuphelelwa umoya kwase kuba kubi kakhulu. Izikena zibonise umsebenzi okhuphukile we-metabolic ku-nodule yamaphaphu engaphezulu kwesokudla, okusikisela kakhulu umdlavuza wamaphaphu. Ukwengeza, ukwanda komsebenzi we-metabolic kwabonwa kuma-lymph nodes amaningi, okuhlanganisa isifunda se-supraclavicular esifanele, i-mediastinum, i-trachea, indawo ye-para-aortic, kanye ne-vena cava ephansi. Izithombe ziphinde zembule ukuqina kwama-nodular amaningi ku-pleura efanele ngomsebenzi owandisiwe we-metabolic. Imiphumela yokuhlolwa yabonisa ukuthi i-pleural metastasis elungile ne-pleural effusion, futhi ukuhlonzwa kokugcina komdlavuza wamaphaphu omncane we-metastatic kwaqinisekiswa ngokuhlolwa kwe-pathological, imaging, kanye ne-immunohistochemistry. Isiguli sabe sesithola ukwelashwa.

Ezinyangeni ezinhlanu kamuva, umthamo wesimila wawunciphe kakhulu, futhi izilonda eziningi ze-metastatic zase zinyamalele. Umuthi wokwelapha wawuhlanganisa i-atezolizumab immunotherapy yokuqala ehlanganiswe nokwelashwa okuhlosiwe kwe-anlotinib. I-Atezolizumab yathathwa ngethamo lika-1200 mg ngosuku lokuqala, okulandelwa ukuma kancane kokwelashwa. I-Anlotinib yanikezwa ngomlomo ngesilinganiso se-10 mg nsuku zonke amasonto amabili alandelanayo, elandelwa isikhathi sokuphumula sezinsuku eziyisikhombisa, okwenza umjikelezo wokwelapha wezinsuku ezingu-21. Ngemva kwamaseshini angu-15 e-radiotherapy, izithombe ze-CT zibonise ukuncipha okuphawulekayo kwesilonda ephashini elifanele, futhi i-mediastinum efanele kanye nama-lymph nodes nawo ancipha kakhulu. I-CT scan yokulandelela ngoSepthemba 10, 2023, yabonisa izinguquko ezinhle: ukuncipha kokuphuma kwe-pleural kwesokudla, ukuncipha kokuqina kwe-pleural kwesokudla, nama-lymph nodes amancane aphakathi nendawo nesokudla, ngaphandle kokwandiswa kwama-lymph nodes esiswini kanye ne-retroperitoneal.

Uma kuqhathaniswa nokuskena ngoMeyi 7, 2023, ukuskena ngo-Okthoba 10, 2023, kubonise ukuncipha okuphawulekayo kwesimila. Ngokuqondile, ukuncipha kwabonwa ku-nodule ku-lobe engaphezulu kwesokudla kanye nama-lymph nodes amaningana eduze kwe-trachea, imithambo yegazi, indawo ye-para-aortic, kanye ne-vena cava engaphansi. Ukuqina kwe-nodular okubonwe ngaphambilini ku-peritoneum yendawo, udonga lwesifuba olungaphambili kwesokudla, kanye nesikhala se-11th-12th intercostal sehle kakhulu. Ukwengeza, isithunzi se-nodular esine-low-density nodular kancane emsipha wehlombe elingakwesokudla nawo sehlile kakhulu. Le miphumela ibonisa ukuthi uhlelo lokwelapha oluhlelekile lwalusebenza kahle, izilonda eziningi ze-metastatic ziyanyamalala futhi izilonda ezisele zincipha kakhulu. Ukuhlolwa kwezithombe kuphakamisa ukuthi uhlobo lokwelapha lube yimpumelelo, futhi isimila manje sisesigabeni sokukhululwa ngokwengxenye.