我父亲肺鳞癌的治疗贴(2014年3月1日驾鹤西去）

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。
& m  b+ I9 r) C. i8 q( O  `2 b/ x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
THERAPE UTIC PERSPECTIVES
J. Mazieres, S. Peters
& \, t' v5 r/ c0 z- a5 i% y7 QIntroduction: 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
  y+ r4 z; ~; e) F# c+ r: voutcomes 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
* F& K) h7 V: P$ |: streatment was delivered after convention al chemothe rapy. A total of 20 anti-Her2
treatments were eval uable. We observed 4 progressive dise ases, 7 disease stabilizations
9 I! a: S! ?# G1 E* Rand 9 partial resp onses according to RECIST 1.1 (overall response rate ORR = 45% ;
: e/ ~! l# \# U9 X. N8 N1 Wdisease control rate DCR = 80%). Specifica lly, we obse rved a DCR of 92% for
trastuzum ab-based therapie s (n = 14), 100 % for afatinib (n = 3) but no response to
/ o( @  P, g6 b+ n1 f3 S! P0 Qlapatinib (n = 2) and to a multiTKI (n = 1). Median survival was of 68.2 months and
0 I) V3 F5 ]; m* l' O; e& y4 I22.9 months for respectively early stage and stag e IV patients.
  Z$ a: v& j( P- x% k2 kConclusion: This study, the largest to date dedic ated to HER2 mutated NSCLC,
reinforces the importance of an HER2 screening strategy in lung adenoc arcinomas .
! b' w3 \7 y* y3 H( b9 C) A9 RHER2-target ed drugs shou ld be tested further, ide ally withi n large collaborative
( S% Z' @2 @/ \4 e$ O! n, Hclinicaltrials.

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
1 ?. r- M/ G- U   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
5 u: b, i" F* l- i7 b( }

谢谢你这么快给我回复，骨转针已打了7针，是否要继续？
CEA为什么会突然变得不敏感呢？再次感谢！

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？

. l, a" Z2 B9 R$ g# n3 d' |" F3 D
因这个项目检查要自费
{:soso_e117:}
8 E/ ^  \" E8 S1 h6 g/ O, V所以......
/ c, ]* s0 `# F. U9 F+ M1 r- C  F下周去检查
9 s& g5 _7 o# C. {, t0 {7 G谢谢老马！