The whole process record of MDT diagnosis and treatment of colon cancer lung metastasis

Case data

Patient Pan Moumou, male, 44 years old

General situation: KPS score of 90 points, 20+ years of smoking history, 20+ years of irregular drinking history, no history of hypertension, diabetes, coronary heart disease, chronic bronchitis,

Characteristics of the medical history: On May 31, 2007, the patient had paroxysmal cramps on the left side of the abdomen when he defecates.

Postoperative pathology: sigmoid colon ulcerative moderately differentiated adenocarcinoma, the tumor infiltrated the full thickness of the intestinal wall to the extraserous fibrous fatty connective tissue lymph nodes and showed cancer metastasis (1/10)

No distant metastases were found on postoperative baseline chest and abdomen CT assessment

Bronchoscopy showed that the lumen of the opening of the lateral segment of the right lower lobe was significantly narrowed, and the mucosa was uneven

Detection of KRAS wild type

Comments from the first MDT discussion:

1.

2.

3.

Conclusion: For colon cancer with lung metastases, neoadjuvant chemotherapy with Erbitux combined with FOLFIRI is recommended

Actual diagnosis and treatment:

Since 2013-03-16, he received 5 times of neoadjuvant chemotherapy with Erbitux combined with FOLFIRI regimen

Comments from the second MDT discussion:

1.

2.

3.

Conclusion: Pulmonary lesion resection was performed, and perioperative comprehensive treatment was completed after operation

Actual diagnosis and treatment:

On 2013-06-14, a right middle and lower lobectomy was performed in our hospital

Comments from the third MDT discussion:

1.

2.
Department of radiotherapy: patients with positive incision margins need postoperative adjuvant chemoradiotherapy
.

3.
Medical oncology: After the patient completed concurrent radiotherapy, the patient continued to complete 6-month perioperative chemotherapy, and continued to receive adjuvant chemotherapy with Erbitux combined with FOLFIRI regimen
.

Conclusions: Erbitux combined with FOLFIRI adjuvant chemotherapy and local concurrent chemoradiotherapy continued
.

Actual diagnosis and treatment:

Later, on July 8, 2013, FOLFIRI + Erbitux adjuvant therapy was given twice, followed by Erbitux + Xeloda concurrent chemoradiotherapy (CTV: 60Gy/30F), and then FOLFIRI + Erbitux chemotherapy was given once again , the last time is October 2013
.

Follow-up results:

Follow-up to December 10, 2015 Ca724: 16.
6U/ML (0-8.
2), no tumor recurrence lesions were found on CT
.
On March 16, 2016, Ca724: 18.
4U/ML (0-8.
2), and CT showed no obvious tumor recurrence
.
20 Jun 2016 Ca724: 25.
2U/ML, Ca199: 61.
2U/ML (0-37)
.
2016-06-23 PET-CT: 1.
The glucose metabolism in the soft tissue adjacent to the right hilum was increased, and the possibility of malignant disease metastasis was considered; 2.
Small nodules were seen in the right lung, and there was no obvious increase in glucose metabolism in the residual lung tissue; 3 gallbladder stones; low density foci in the spleen
.
Combined with clinical
.

Comments from the fourth MDT discussion:

1.
Department of Imaging: During the follow-up period of the patient, the PET-CT parahilar soft tissue increased glucose metabolism, and combined with the medical history, postoperative recurrence of colorectal cancer with mediastinal lymph node metastasis was considered

2.
Cardiothoracic surgery: The patient has undergone surgery for hilar metastases in the past, and now the mediastinal recurs again, and reoperation is not considered
.

3.
Radiotherapy department: There was no new metastasis in both lungs of the patient, and PET-CT showed local recurrence.
According to the last radiotherapy time, it was nearly 3 years, and radiotherapy and chemotherapy in the mediastinal lymph node area could be considered again.
Large, it is recommended to perform conventional concurrent chemoradiotherapy, Xeloda radiotherapy sensitization
.

4.
Medical oncology: The patient has tumor recurrence, but only local recurrence of mediastinal lymph nodes.
The treatment is mainly local treatment, and systemic intravenous chemotherapy is not considered
.

Conclusion: Routine concurrent chemoradiotherapy in the mediastinal lymph node region was performed
.

Actual diagnosis and treatment:

In June 2016, Gamma Knife treatment was performed in a hospital in Shanghai.
After follow-up, Ca724 and Ca199 gradually decreased to normal
.
2016-08-30 Re-examination of CT showed sigmoid colon K and right lung metastases after operation, the right lower lung lesions were similar to the previous film on 2015-12-11, and there were multiple irregular nodules in the right lung.
Considering the possibility of chronic inflammatory changes, the metastasis was pending.
The left lower lung nodule was similar to the previous one, the right pleura was thickened, and there were multiple stones in the gallbladder
.
Follow-up observation was conducted again
.

follow-up

Follow-up to April 2017, Ca199 54.
8U/ML, cough, expectoration, blood in sputum symptoms, little blood in sputum, and mild chest tightness and discomfort, re-examination CT in 2017-04 showed: sigmoid colon K and right lung After metastases, the right lower lung disease progressed compared with the previous film on 2016-08-30, and the left lower lung nodule was similar to the previous film; fatty liver; multiple gallbladder stones
.

Comments from the fifth MDT discussion:

1.
Imaging Department: The patient has a large consolidation lesion in the right lung, and has a history of radiotherapy.
It is considered that atelectasis and lung consolidation are caused by radiotherapy
.

2.
Department of Radiotherapy: The patient’s right lung disease was considered as a post-radiotherapy complication.
The high local dose of mediastinal gamma knife treatment caused the collapse of the bronchial wall, resulting in radiation pneumonitis, atelectasis with lung consolidation, chest tightness and cough.
Blood symptoms, it is recommended to be anti-inflammatory, hormone shock symptomatic treatment
.

3.
Medical oncology: pulmonary lesions appear during the follow-up of the patient, considering the complications after radiotherapy, no evidence of tumor recurrence, and no need for palliative chemotherapy
.
Regular follow-up is recommended after symptomatic treatment
.

Conclusion: Symptomatic treatment and continued follow-up
.

Actual diagnosis and treatment:

After symptomatic treatment such as anti-inflammatory and hormones, the symptoms of chest tightness and phlegm and blood disappeared, and the fluctuation of Ca724 was between 40-70U/ML
.