肺腺癌脑转移--2016-04-20幻灯片.ppt

Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,简要病史,马,XX,，女，,50,岁，病案号,1602481,。,现病史：,2015,年,2,月份出现刺激性干咳，无头痛头晕，门诊查,CT,（,2015-04-29,）示：左上肺软组织团块影，考虑肺,Ca,。后在我院胸外科住院，查,CEA:23.58ng/ml,、,CY211,：,3.77ng/ml,，其他肿标正常；增强,CT(2015-4-30):,左上肺软组织团块影，增强后不均匀强化；腹部,CT,未见异常。,现病史：,头颅,CT,（,2015-4-30):1.,颅内多发结节，考虑转移，建议,MRI,。具体示：左侧额叶、右侧颞叶见多发结节样高低密度影，较大直径约,24mm,。,2015-05-06,省肿瘤医院行肺穿刺，病理（病理号,1504282,）：腺癌，中分化为主,(,未做基因检测,),。,简要病史,简要病史,2015-04-30,简要病史,2015-04-30,简要病史,简要病史,现病史：,我科：查,CEA:22.94ng/ml,；,CY211,：,3.77ng/ml,。,2015-05-11,：培美曲塞,0.8g d1+,顺铂,40mg d1-3,2015-05-21,：全脑,DT30Gy/10Fx,，左脑转移灶加量,DT18Gy/3F,。,化放疗后评估：,CEA:17.91ng/ml,；,CY211,正常。胸部,CT,示病灶稳定；头颅,MRI,：头颅多发病变，但直径最大者约,19mm(,较前缩小,),。,简要病史,2015-07-11,简要病史,现病史：,2015-07-12,、,08-6,、,08-31,、,09-24,：培美曲塞,0.8g d1+,顺铂,20mg d1-54,周期。,期间查,CEA:,14.17 12.838.348.59ng/ml,3,周期复查,CT:,左上肺占位，较,2015-07-11,片有缩小。,4,周期复查：,CT:,左上肺占位，较,2015-07-11,片有缩小。头颅,MRI:,颅内多发转移瘤,较前片,2015-06-18,略好转。,简要病史,3,周期后,2015-08-29,简要病史,3,周期后,2015-08-31,简要病史,现病史：,2016,年,1,月份出现右侧肢体活动障碍，稍有头晕，右侧肢体肌力为,3,级，,KPS50,分，,PS2,分。查,CEA18.3ng/ml,CY211,：,3.77ng/ml;CT(2016-1-25):1.,左肺上叶占位，较,2015-08-29,片进展,2.,两肺散在纤维化灶,3.,肝左内叶稍低密度影，建议,MR,平扫及增强扫描；,MRI(2016-1-25):,左侧额叶转移瘤，较前片,2015-08-31,增大。,简要病史,2016-01-25,简要病史,2016-01-25,简要病史,初步诊断：,左肺腺癌多发脑转移放化疗后,期,KPS 50,分,病情评估：,PD,下一步治疗,？,简要病史,建议,EGFR,检测，拒绝。,2016-01-28,开始易瑞沙,250mg qd,。,2016-03-08,我科复查：,6.75ng/ml,，,KPS,评分,70,分，,PS1,分，右侧肢体活动障碍较前好转，肌力较前改善，,4,级。,讨论,1,、化疗、靶向治疗如何安排？,2,、无症状性脑转移何时放疗,?,谢谢,