| 摘要 |
Lung cancer was the most common cause of cancer death in Taiwan in 2006, and
about 30 to 40 percent of lung cancer cases have adenocarcinoma. Surgical resection
is preferred for patients with stage I non-small cell lung cancer, but for patients with
stage IIIb, the options for treatment are diverse. Pancreatic cancer was the eighth
largest cause of cancer death in Taiwan in 2006, and surgical resection is the only
curative chance. However, only about 15 to 20 percent of pancreatic cancer patients
can undergo curative resection. Gefitinib (Iressa®) is a quinazoline derivative, which
is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor and is
clinically used for patients with solid tumors, including non-small cell lung cancer.
We examined a 72-year-old Taiwanese man with adenocarcinoma of unknown
primary, including lung adenocarcinoma, cT4N3M0, stage IIIb, and pancreatic
adenocarcinoma with stomach invasion, cT4N1M0, stage III at initial diagnosis on
May 24, 2005. After treatment with gefitinib for his lung cancer and concurrent
chemoradiotherapy (CCRT) for his pancreatic cancer, he underwent successful
surgical procedures including distal pancreatectomy, splenectomy, gastric wedge
resection and segmental resection of the transverse colon. The final pathologic
diagnosis was pancreatic tail cancer, ductal adenocarcinoma with stomach invasion,
ypT3N0M0, stage IIa. Seventeen months after the operation, no residual lung or
pancreatic tumor was noted. Double primary cancers of the lung and pancreatic
adenocarcinoma were favored by the pathologist because of the morphologic
findings and the immunohistochemical staining of thyroid transcription factor-1
(TTF-1), which is specific to lung adenocarcinoma. Gefitinib treatment in this case
probably contributed to the remission of non-small cell lung cancer, and allowed
complete resection of pancreatic cancer after CCRT. |
