救治性手术联合放疗与化疗序贯免疫检查点抑制剂治疗复发转移舌鳞癌1例报道

doi:10.3969/j.issn.1674-8115.2021.12.023

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (12): 1704-1708.doi: 10.3969/j.issn.1674-8115.2021.12.023

• 病例报告 • 上一篇

救治性手术联合放疗与化疗序贯免疫检查点抑制剂治疗复发转移舌鳞癌1例报道

丁继平¹(), 李晓光², 刘忠龙², 邓刚², 姚原¹, 何悦²()

^1.上海交通大学医学院附属第九人民医院肿瘤放疗科，上海 200011
^2.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011

收稿日期:2021-05-11 出版日期:2021-12-28 发布日期:2022-01-28
通讯作者: 何悦 E-mail:dingjiping2013@163.com;william5218@126.com
作者简介:丁继平（1983—），男，主治医师，硕士；电子信箱：dingjiping2013@163.com。
基金资助:
上海市教育委员会高峰高原学科建设计划(20152222);上海交通大学医学院附属第九人民医院基础研究助推计划(JYZZ055)

A case report of recurrent and metastatic tongue squamous cell carcinoma treated with salvage surgery combined with chemoradiotherapy and sequential immune checkpoint inhibitor

Ji-ping DING¹(), Xiao-guang LI², Zhong-long LIU², Gang DENG², Yuan YAO¹, Yue HE²()

^1.Department of Radiation Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^2.Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China

Received:2021-05-11 Online:2021-12-28 Published:2022-01-28
Contact: Yue HE E-mail:dingjiping2013@163.com;william5218@126.com
Supported by:
Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20152222);Fundamental Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYZZ055)

摘要/Abstract

摘要：

患者，男，55岁，左舌鳞癌术后5年复发。患者因体质差、病灶范围广泛，入院后先行介入治疗但效果不佳，后行复发舌癌的救治性手术。术后仅1个月又发生双侧颈部淋巴结转移，予颈部淋巴结清扫术辅以放射治疗和化学治疗。放射治疗结束后1个月，两肺转移灶进一步增大。予化学治疗联合免疫检查点抑制剂治疗4个周期后转移灶全部消失。免疫检查点抑制剂单药维持9个周期后因发生免疫性心肌炎而停药，疗效评价达到完全缓解。

关键词: 舌癌, 救治性手术, 复发, 转移, 免疫检查点抑制剂, 放射治疗

Abstract:

A 55-year-old male patient was admitted to hospital with recurrence of left tongue cancer 5 years after surgery. The patient with poor physical fitness and extensive lesions received salvage surgery for recurrent tongue cancer. Only 1 month after operation, bilateral cervical lymph node metastasis occurred. Cervical lymph node dissection was performed sequentially with radiotherapy and chemotherapy. One month after the end of radiotherapy, the metastatic foci in both lungs further increased. After 4 cycles of chemotherapy combined with immune checkpoint inhibitor, all the metastases disappeared. After 9 cycles of immune checkpoint inhibitor maintenance, the drug was stopped due to the occurrence of immune myocarditis, and the efficacy evaluation achieved complete remission.

Key words: tongue cancer, salvage surgery, recurrence, metastasis, immune checkpoint inhibitor, radiotherapy

中图分类号:

R739.8

丁继平, 李晓光, 刘忠龙, 邓刚, 姚原, 何悦. 救治性手术联合放疗与化疗序贯免疫检查点抑制剂治疗复发转移舌鳞癌1例报道[J]. 上海交通大学学报(医学版), 2021, 41(12): 1704-1708.

Ji-ping DING, Xiao-guang LI, Zhong-long LIU, Gang DENG, Yuan YAO, Yue HE. A case report of recurrent and metastatic tongue squamous cell carcinoma treated with salvage surgery combined with chemoradiotherapy and sequential immune checkpoint inhibitor[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1704-1708.

图/表 5

图1 PET/CT示舌癌术后复发

Fig 1 Recurrence of tongue cancer showed by PET/CT

图2 复发舌癌的救治性手术Note： A. After excision of the primary tumor. B. Tumor excision specimen. C. Repairing the surgical space with anterolateral thigh flap.

Fig 2 Salvage surgery for recurrent tongue cancer

图3 救治性术后1个月PET/CT示双侧颈部淋巴结转移

Fig 3 Bilateral cervical lymph node metastasis 1 month after salvage surgery showed by PET/CT

图4 肺CT显示两肺结节治疗前后变化Note： A. Multiple microscopic nodules (arrows) in both lungs before radiotherapy. B. Multiple nodules (arrows) significantly increased in both lungs 1 month after the end of radiotherapy. C. Multiple nodules disappeared in both lungs after chemotherapy combined with immunotherapy.

Fig 4 Changes of pulmonary nodules before and after treatment showed by CT

图5 救治性手术后15个月PET/CT图像示完全缓解

Fig 5 CR showed by PET/CT 15 months after salvage surgery

参考文献 31

1	Marur S, Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment[J]. Mayo Clin Proc, 2016, 91(3): 386-396.
2	张志愿, 张陈平. 口腔颌面部及头颈部肿瘤患者救治性手术[J]. 中国医学文摘(耳鼻咽喉科学), 2007, 22(6): 319-320.
3	王友元, 张大明, 范松, 等.局部晚期复发口腔癌挽救性手术近期疗效分析[J].中国口腔颌面外科杂志, 2015, 13(4): 341-347.
4	陈睿, 杨朝晖, 陈伟良, 等.18例侵犯颈动脉的复发性口腔、口咽鳞状细胞癌的挽救性手术治疗效果评价[J].中国口腔颌面外科杂志, 2017, 15(3): 277-281.
5	Tian Z, Wang S, Xia R, et al. Salvage surgery for recurrent tongue cancer with contralateral neck metastasis [J]. J Oral Maxillofac Surg, 2021, 79(2): 490-500.
6	Zhong LP, Zhang CP, Ren GX, et al. Randomized phase Ⅲ trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma [J]. J Clin Oncol, 2013, 31(6): 744-751.
7	Borsetto D, Higginson JA, Aslam A, et al. Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma[J]. J Oral Pathol Med, 2019, 48(3): 206-213.
8	Leeman JE, Li JG, Pei X, et al. Patterns of treatment failure and postrecurrence outcomes among patients with locally advanced head and neck squamous cell carcinoma after chemoradiotherapy using modern radiation techniques[J]. JAMA Oncol, 2017, 3(11): 1487-1494.
9	黄冠江, 张靖萱, 罗梦思, 等.复发性头颈鳞状细胞癌的挽救性手术的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(20): 1659-1663.
10	陈义波, 李超, 周雨秋, 等.晚期复发舌癌挽救性手术和一蒂三瓣修复全舌及颈部复杂缺损1例[J]. 中国肿瘤临床, 2017, 44(22): 1165-1166.
11	Tam S, Araslanova R, Low TH, et al. Estimating survival after salvage surgery for recurrent oral cavity cancer[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(7): 685-690.
12	Van Weert S, Leemans CR. Salvage surgery in head and neck cancer[J]. Oral Dis, 2021, 27(1): 117-124.
13	Horn D, Bodem J, Freudlsperger C, et al. Outcome of heavily pretreated recurrent oral squamous cell carcinoma after salvage resection: a monocentric retrospective analysis[J]. J Craniomaxillofac Surg, 2016, 44(8): 1061-1066.
14	Horn D, Zittel S, Moratin J, et al. Prospective feasibility analysis of salvage surgery in recurrent oral cancer in terms of quality of life[J]. Oral Oncol, 2020, 102: 104580.
15	Jung TY, Sung KW, Park SY, et al. Salvage surgery with second free flap reconstruction for recurrent oral squamous cell carcinoma [J]. Heliyon, 2020, 6(6): e04014.
16	Patil VM, Noronha V, Thiagarajan S, et al. Salvage surgery in head and neck cancer: does it improve outcomes? [J]. Eur J Surg Oncol, 2020, 46(6): 1052-1058.
17	廖贵清, 苏宇雄, 侯劲松, 等. 累及相邻器官的晚期舌癌的手术治疗: 附1例报告[J]. 中国口腔颌面外科杂志, 2004, 2(4): 309-311.
18	徐立群, 张陈平, 竺涵光, 等.晚期头颈肿瘤术后合并肺不张的诊治体会(附1例报告)[J].上海口腔医学, 2002, 11(1): 84-85.
19	Chung EJ, Park MW, Kwon KH, et al. Clinical outcomes and prognostic factor analysis after salvage surgery for recurrent squamous cell carcinoma of the oral cavity[J]. Int J Oral Maxillofac Surg, 2020, 49(3): 285-291.
20	Ganan L, Lopez M, Garcia J, et al. Management of recurrent head and neck cancer: variables related to salvage surgery[J]. Eur Arch Otorhinolaryngol, 2016, 273(12): 4417-4424.
21	Hosni A, Huang SH, Chiu K, et al. Predictors of early recurrence prior to planned postoperative radiation therapy for oral cavity squamous cell carcinoma and outcomes following salvage intensified radiation therapy[J]. Int J Radiat Oncol Biol Phys, 2019, 103(2): 363-373.
22	Chen W, Yang Z, Zhang D, et al. Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma[J]. Int J Oral Maxillofac Surg, 2014, 43(5): 531-538.
23	Das Majumdar SK, Sahoo TK, Parida DK. Cutaneous and cardiac metastases in carcinoma of anterior tongue [J]. J Cancer Res Ther, 2020, 16(3): 680-682.
24	Szturz P, Vermorken JB. Translating KEYNOTE-048 into practice recommendations for head and neck cancer[J]. Ann Transl Med, 2020, 8(15): 975.
25	郭伟.晚期头颈恶性肿瘤程序性细胞死亡蛋白1免疫治疗的临床研究述评[J].华西口腔医学杂志, 2020, 38(5): 489-494.
26	Burtness B, Harrington KJ, Greil R, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study[J]. Lancet, 2019, 394(10212): 1915-1928.
27	Ferris RL, Blumenschein G, Fayette J, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck[J]. N Engl J Med, 2016, 375(19): 1856-1867.
28	Ueki Y, Takahashi T, Ota H, et al. Role of programmed death-ligand 1 in predicting the treatment outcome of salvage chemotherapy after nivolumab in recurrent/metastatic head and neck squamous cell carcinoma [J]. Head Neck, 2020, 42(11): 3275-3281.
29	Kraft S, Gadkaree SK, Deschler DG, et al. Programmed cell death ligand-1 and cytotoxic T cell infiltrates in metastatic cutaneous squamous cell carcinoma of the head and neck [J]. Head Neck, 2020, 42(11): 3226-3234.
30	Tang X, Chen SQ, Sui QQ, et al. Response to nivolumab combining radiotherapy and nimotuzumab in metastatic oral squamous cell carcinoma patient with strong PD-L1 expression: a case report[J]. Ann Transl Med, 2020, 8(6): 402.
31	Szturz P, Vermorken JB. Management of recurrent and metastatic oral cavity cancer: raising the bar a step higher[J]. Oral Oncol, 2020, 101: 104492.

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救治性手术联合放疗与化疗序贯免疫检查点抑制剂治疗复发转移舌鳞癌1例报道

A case report of recurrent and metastatic tongue squamous cell carcinoma treated with salvage surgery combined with chemoradiotherapy and sequential immune checkpoint inhibitor

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