我父亲肺鳞癌的治疗贴(2014年3月1日驾鹤西去）

/ q. y! B7 J% P& y( ~1 \0 F, W% o
) _3 f3 l: O" |/ e$ {1 _) x祝老马老师新年快乐！今天看了你的，《肺癌骨转移的双膦酸盐治疗》这篇文章，想有个问题请教你：我父亲由于手术前未确定病灶的良性还是恶性，所以先行手术，确定恶性后，手术后补做了骨扫描，结论：右侧股骨颈骨代谢增高灶，建议进一步检查。三个月后核磁复查：右侧髂骨、股骨头、股骨颈见结节状异常信号T1WI低信号、T2WI高信号。左侧股骨头见斑点状T2W1高信号影，髋臼及关节间隙如常，左侧髋关节囊见少量积液。结果诊断：右侧髂骨、股骨颈及两侧股骨头异常信号。问过好多医生，未能诊断是否骨转移。术后至今已7月多，一直未疼痛，碱性磷酸酶也正常，请问老师骨转移的可能性大吗？

我觉得骨转移可能性大，建议再做个核磁，看看有什么变化没有。
确定后可以打骨转针。
肿瘤指标有没有检查？

谢谢马老师这么快回复;肿瘤指标有检查,CEA手术前5.6,手术后2.7,总共四次培美曲塞+顺伯,前三次后CEA都在2.7左右,第四次后4.22,现在3.6,现在跟正常人一模一样,体重回升3公斤,正常上班,真想现在的好时光能长点,再长点.

LUNG CANCER HARB ORING HER2 MUTATION :EPIDE MIOLOGI CAL CHARACTE RISTICS AND
7 e% A) K3 u6 GTHERAPE UTIC PERSPECTIVES
9 {( l, a  w0 v, \J. Mazieres, S. Peters
3 a. a$ x8 j$ Q" H* ?! ?Introduction: HER2 oncogene is a memb er of the EGFR family, encoding atransmembrane receptor that drives and regulates cell proliferation. HER2 mutations are identified in about 2% of non small cell lung cancer (NSCLC) , mainly located in exon 20, and appear to be critical for lung cancer carcinogenesis . Very scarce data are available to define a clinical profile of the patients harboring HER2 mutated NSCLC. We aimed to study clinic opatholog ical characteristics an d therapeutic
outcomes of patients harboring HER2 mutation in a large European series. Result s:We retrospec tively ide ntified 46 NSCLC patients diagn osed with HER2 exon 20 mut ation. HER2 mutation was mainly exclusive as only one concomitan t KRas mutation was des cribed. Our population was characterized by a median age of 60 yr (31 to 86 yr), a high proportion of women (30 vs. 16 men, 65% ), and of never smokers (24, 52%). All tumors were adenoc arcinomas (two with lepidic features). Half of the patients had stage IV dise ase at the time of diagnosis. HER2 targeted
/ P! q) d1 B) L5 ]+ Z0 X2 \treatment was delivered after convention al chemothe rapy. A total of 20 anti-Her2
4 n% _* Y' b  p: |! A2 Dtreatments were eval uable. We observed 4 progressive dise ases, 7 disease stabilizations
; J+ [+ ^4 T) b7 J" z' B) h7 Band 9 partial resp onses according to RECIST 1.1 (overall response rate ORR = 45% ;
disease control rate DCR = 80%). Specifica lly, we obse rved a DCR of 92% for
4 j: E; w/ N7 G/ E% z+ C9 C- h$ a3 [' d$ Ptrastuzum ab-based therapie s (n = 14), 100 % for afatinib (n = 3) but no response to
lapatinib (n = 2) and to a multiTKI (n = 1). Median survival was of 68.2 months and
9 K8 m7 W9 z+ p, b( D22.9 months for respectively early stage and stag e IV patients.
Conclusion: This study, the largest to date dedic ated to HER2 mutated NSCLC,
1 D9 [* X0 ?2 E, U+ Ereinforces the importance of an HER2 screening strategy in lung adenoc arcinomas .
( k! v1 t5 Q$ w: o* AHER2-target ed drugs shou ld be tested further, ide ally withi n large collaborative
clinicaltrials.
: r2 C; w. R. Z& p* j) K

老马：你好！一口气看完你的帖子，受益非浅，现在有问题想向你请教一下
   最近非常纠结于我爸爸的下一步治疗情况，想请教一下您，麻烦帮我看看他的CEA算敏感的吗？为什么最近CEA变化和肿瘤大小变化怎么不符合了呢？目前CT象征肿瘤算不算增大了呢？是否能继续空窗或者用靶向？以下是治疗帖。http://www.yuaigongwu.com/thread-8252-1-1.html

谢谢你这么快给我回复，骨转针已打了7针，是否要继续？
' F  D8 G* k* F& E) E9 ]% C  PCEA为什么会突然变得不敏感呢？再次感谢！

8 U1 f/ C2 a  o8 n& R

经常上来，但是第一次注册。 父也是肺鳞癌！

向老马请教，病人的淋巴细胞亚群检测是不是很重要？

: b$ P  A  l1 W
0 q7 Z' j) l8 z2 O) k' K) O+ G因这个项目检查要自费
/ H& B; D" X1 b: {) }1 R{:soso_e117:}
所以......
& ^5 M' @. g3 f: e, J# f下周去检查
' V, [& @5 r1 r( w1 }谢谢老马！