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。
0 G, |2 Q, N7 d" K8 `确定后可以打骨转针。
8 A, z% b  }+ [' m) L; W) K2 I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
7 P' [7 c, m! d* D( [1 oTHERAPE UTIC PERSPECTIVES
J. 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
  a* |& s  H7 Dtreatment was delivered after convention al chemothe rapy. A total of 20 anti-Her2
0 G* @) g7 ?1 G4 z7 B* U; N* Wtreatments were eval uable. We observed 4 progressive dise ases, 7 disease stabilizations
" u* u  Y2 J" {and 9 partial resp onses according to RECIST 1.1 (overall response rate ORR = 45% ;
8 V' [9 l5 K) H+ w0 l7 d7 o3 r$ I0 @+ |disease control rate DCR = 80%). Specifica lly, we obse rved a DCR of 92% for
. ?( n; l! v, b1 ntrastuzum ab-based therapie s (n = 14), 100 % for afatinib (n = 3) but no response to
  ~3 _2 |2 R* \  B8 G* Dlapatinib (n = 2) and to a multiTKI (n = 1). Median survival was of 68.2 months and
  A$ d1 D8 T7 z7 p/ x& h22.9 months for respectively early stage and stag e IV patients.
Conclusion: This study, the largest to date dedic ated to HER2 mutated NSCLC,
reinforces the importance of an HER2 screening strategy in lung adenoc arcinomas .
/ \; H# f% T' b( ]6 KHER2-target ed drugs shou ld be tested further, ide ally withi n large collaborative
clinicaltrials.

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 n  L! ^' r! [, i3 S   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 r. r( N5 r( f* o, `7 r

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！

+ ?4 i/ X9 C; d4 b. W$ V+ m0 E3 C

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？

因这个项目检查要自费
{:soso_e117:}
. ], L& V& l" a. f; H+ F所以......
+ o3 }* c- W5 d1 g% j下周去检查
谢谢老马！