我父亲肺鳞癌的治疗贴(2014年3月1日驾鹤西去）

: F+ K9 C: ?9 V' m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。
& B7 z( |) k9 G+ g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
+ y  v7 ]; C" V$ ?- z& o1 qJ. Mazieres, S. Peters
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
* e0 j- J. P2 mtreatment 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
2 N5 T1 p, l3 R- [+ c( m5 W4 b  {- qand 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
+ N! n, K7 r" D& dtrastuzum 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
& d$ v8 @& L2 V; f8 y* T22.9 months for respectively early stage and stag e IV patients.
Conclusion: This study, the largest to date dedic ated to HER2 mutated NSCLC,
/ z( O. N) K7 p( l% j; g3 F$ zreinforces the importance of an HER2 screening strategy in lung adenoc arcinomas .
3 A7 n( ~, Q, W7 VHER2-target ed drugs shou ld be tested further, ide ally withi n large collaborative
/ I$ e4 y- e# F  g2 F+ Zclinicaltrials.

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
* {: _+ w2 k& i: L   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
! r; ~' i. x3 Q2 H& e

谢谢你这么快给我回复，骨转针已打了7针，是否要继续？
* z/ Y. i7 p% `6 I6 E0 M1 C! @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？

  X! N8 }( Q6 A% o
因这个项目检查要自费
{:soso_e117:}
所以......
. v/ z) P4 ^+ W$ W7 R下周去检查
* C* q  h0 T) E  R3 D. G7 R, O谢谢老马！