Umdlavuza wamaphaphu we-Metastatic small cell lung cancer-01

NgoJuni 2022, isiguli sesilisa esineminyaka engu-65 ubudala sahlolwa ngokomzimba njalo, kwathi i-CT scan yaveza iqhubu ngaphansi kwe-pleura engxenyeni ephezulu kwesokudla yamaphaphu. NgoJanuwari 2023, isiguli saqala ukuzwa izimpawu ezifana nokuhosha, ukukhwehlela, kanye nokuphefumula kanzima. NgoMeyi 2023, ukukhwehlela kwaso kanye nokuphefumula kanzima kwase kubi kakhulu. Ama-scan abonise ukwanda okukhulu komsebenzi wokusebenza komzimba endaweni ephezulu kwesokudla yamaphaphu, okubonisa kakhulu umdlavuza wamaphaphu. Ngaphezu kwalokho, ukwanda komsebenzi wokusebenza kahle kwabonakala kuma-lymph node amaningi, kufaka phakathi indawo ye-supraclavicular kwesokudla, i-mediastinum, i-trachea, indawo ye-para-aortic, kanye ne-inferior vena cava. Izithombe ziphinde zembula ukuqina kwamaqhubu amaningi ku-pleura kwesokudla kanye nomsebenzi wokusebenza kahle kakhulu. Imiphumela yokuhlolwa ibonise ukusabalala kwamaqhubu kwesokudla kanye ne-pleural effusion, kanti ukuxilongwa kokugcina komdlavuza wamaphaphu we-metastatic small cell kwaqinisekiswa ngokuhlolwa kwe-pathological, i-imaging, kanye ne-immunohistochemistry. Isiguli sabe sesithola ukwelashwa ngenkuthalo.

Ezinyangeni ezinhlanu kamuva, umthamo wesimila wawunciphile kakhulu, futhi izilonda eziningi ezisakazekile zase zinyamalele. Uhlelo lokwelashwa lwaluhlanganisa ukwelashwa kokuqala kwe-atezolizumab immunotherapy kuhlanganiswe nokwelashwa okuqondiswe ku-anlotinib. I-Atezolizumab yanikezwa ngomthamo we-1200 mg ngosuku lokuqala, kwalandela ikhefu lokwelashwa. I-Anlotinib yanikezwa ngomlomo ngomthamo we-10 mg nsuku zonke amasonto amabili alandelanayo, kwalandela isikhathi sokuphumula sezinsuku eziyisikhombisa, kwakha umjikelezo wokwelashwa wezinsuku ezingu-21. Ngemva kwezikhathi ezingu-15 zokwelashwa ngemisebe, izithombe ze-CT zabonisa ukwehla okukhulu kwesilonda emaphashini angakwesokudla, kanti i-mediastinum yangakwesokudla kanye nama-lymph node nawo anciphile kakhulu. I-CT scan elandelayo ngoSepthemba 10, 2023, yabonisa izinguquko ezinhle: ukwehla kokuphuma kwe-pleural yangakwesokudla, ukwehla kokuqina kwe-pleural yangakwesokudla, kanye nama-lymph node amancane e-mediastinal kanye ne-supraclavicular supraclavicular, ngaphandle kokukhula kwama-lymph node esiswini nase-retroperitoneal.

Uma kuqhathaniswa nokuskena okwenziwe ngoMeyi 7, 2023, ukuskena okwenziwe ngo-Okthoba 10, 2023, kubonise ukwehla okukhulu kwesimila. Ngokukhethekile, ukushwabana kwabonakala ku-nodule ku-lobe ephezulu kwesokudla kanye nasezindaweni eziningana ze-lymph eduze kwe-trachea, imithambo yegazi, indawo ye-para-aortic, kanye ne-inferior vena cava. Ukuqina kwama-nodular okubonwe ngaphambilini ku-peritoneum yendawo, udonga lwesifuba olungaphambili lwesokudla, kanye nesikhala se-intercostal se-11th-12th kwase kwehle kakhulu. Ngaphezu kwalokho, isithunzi sama-nodular esinobukhulu obuphansi kancane emisipheni yehlombe lesokudla naso sehle kakhulu. Le miphumela ikhombisa ukuthi uhlelo lokwelapha oluhlelekile lwalusebenza kahle, kanti izilonda eziningi ezisakazekile ziyanyamalala kanti izilonda ezisele zincipha kakhulu. Ukuhlolwa kwezithombe kusikisela ukuthi uhlelo lokwelapha luphumelele, futhi isimila manje sisesigabeni sokuxolelwa okuyingxenye.