Page 59 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine Refractory pulmonary adenocarcinoma

A B C D

E F

Figure 2. (A) The lesion in the lower lobe of the left lung after radiotherapy: The whole-body bone scan showed the right humerus, the sixth rib on the
left, and the first lumbar vertebra with increased radioactivity. (B) After six cycles of chemotherapy: Computed tomography (CT) examination showed
the nodule sized 10 mm × 5 mm in the lower lobe of the left lung. (C) Three months after six cycles of chemotherapy: CT scan showed the nodule sized
11 mm × 10 mm in the lower lobe of the left lung. (D) Three months after radiotherapy: CT images showed the nodule sized 16 mm × 12 mm nodules with
increased solid parts in the lower lobe of the left lung. (E and F) After treatment with traditional Chinese medicine: The magnetic resonance imaging scan
showed a high signal shadow with local enhancement on enhanced scanning in the left cerebellar hemisphere.

prognosis. Within 20 months after the diagnosis of the positive expression of programmed death ligand 1 would
disease, the patient received targeted therapy (ametinib benefit from treatment of targeted and immunosuppressive
and bevacizumab), chemical therapy (pemetrexed therapy such as icotinib and separizumab [3,5-7] . However,
with cisplatin), radiation therapy, and immunotherapy there have been scarce research and reports of refractory
(separizumab). However, clinical outcomes were severely pulmonary adenocarcinoma which responded poorly
poor for this relatively rare refractory pulmonary to medical therapy. At present, the research on drug
adenocarcinoma, even after robust medical therapy, and resistance in lung adenocarcinoma mainly focuses on
the patient died in 2 years. targeted therapy and immunotherapy, but the auxiliary
therapeutic effect of traditional Chinese medicine cannot
3. Discussion be ignored. The overall survival period of patients who

Papillary carcinoma is known for its aggressive growth received pemetrexed maintenance therapy was longer
pattern and clinical behavior, which necessitates extensive than those who did not receive the therapy [5,8,9] . Chinese
research and individualized treatment approaches . Medical Association guidelines for clinical diagnosis and
[1]
Strengthening the understanding of different pathological treatment of lung cancer (2022 edition) recommend that
subtypes of pulmonary adenocarcinomas, such as patients with good performance status (PS) score and good
invasive mucinous adenocarcinoma, colloid, fetal, and chemotherapy tolerance may accept maintenance therapy
enteric adenocarcinoma, is essential for prognostic when patients undergo 4–6 cycles of chemotherapy
improvement . Chemotherapy is a first-line treatment to improve their disease control, including complete
[2]
[10]
method for advanced lung adenocarcinoma, mainly remission, partial remission, and stability . In this patient,
including platinum-based dual drug combination with a PS score of 1, the lung lesion was significantly
chemotherapy (such as pemetrexed and cisplatin) and reduced after six cycles of chemotherapy, but maintenance
non-platinum based dual drug combination chemotherapy treatment was not continued, which may be related to the
(such as capecitabine and cisplatin) . Targeted therapy progress of the patient’s condition.
[3]
could prolong the survival period and improve the life
quality of patients, following the significant progression in 4. Conclusion
recent research works . Many researchers indicated that This case suggests that it is necessary to perform F-FDG
18
[4]
patients with EGFR and EML4-ALK gene mutations and PET/CT before tumor therapy. The treatment of refractory
Volume 1 Issue 1 (2023) 3 https://doi.org/10.36922/arnm.0883