The characteristics of 256-slice computer tomography in diagnosis and follow-up in patients with EGFR-mutated lung adenocarcinoma

Dr Nguyen Viet Dung1, A.Prof Nguyen Quoc Dung1,
1 Huu Nghi Hospital

Main Article Content

Abstract

SUMMARY


Purpose: The characteristics of 256-slice computer tomography in patients with EGFR-mutated lung adenocarcinoma and the tumor response to targeted therapy according to RECIST 1.1 criteria were taken into investigation in this study.
Methods: 32 patients with EGFR- mutated lung adenocarcinoma received TKI (tyrosine kinase inhibitor) were underwent 256 slice CT scanner before treatment and 3 months, 6 months of treatment, from July 2017 to July 2019 at Friendship Hospital.
Results: Before therapy, on 256-slice CT scanner in patients with EGFR-mutated lung adenocarcinoma, we observed tumors on the right in 56.3% of patients, tumors in the upper lobe in 56.3%, tumors size larger than 3 cm in 81.3%, lobulated or spiculated margin in 100%, pleural effusion in 50%, air bronchogram in 34.4% and cavitation in 3.1%. Metastases was present in lymph nodes in 68.8%, followed by metastatic deposits in lung (56.3%), bone (53.1%), brain (9.4%), adrenal gland (9.4%) and liver (6.3%). After 3 months of treatment , the percentage of partial response was 34.4%, stable disease was 59.4% and progressive disease was 6.3%; after 6 months, these ratio were 40.6%, 43.8% and 15.6% respectively.
Conclusion: Common CT scanner features in patients with EGFRmutated lung adenocarcinoma were lobulated or spiculated margin, size larger than 3cm and pleural effusion; cavitation was rarely noticed. Metastases usually presented in lymph node, lung and bone. The disease control rate at 3 months and 6 months of therapy were 93.7% and 84.4% respectively. CT scanner is a potential tool for evaluating tumor response and improving effective treatment in patients with lung cancer received TKI.

Article Details

References

TÀI LIỆU THAM KHẢO
1. Dela Cruz C.S., Tanoue L.T., và Matthay R.A. (2011). Lung Cancer: Epidemiology, Etiology, and Prevention. Clinics in Chest Medicine, 32(4), 605–644.
2. Lim R.B.L. (2016). End-of-life care in patients with advanced lung cancer. Ther Adv Respir Dis, 10(5), 455–467.
3. Rosell R., Carcereny E., Gervais R. và cộng sự. (2012). Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol, 13(3), 239–246.
4. Eisenhauer E.A., Therasse P., Bogaerts J. và cộng sự. (2009). New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). European Journal of Cancer, 45(2), 228–247.
5. Trần Lê Sơn, Bùi Văn Giang, và Trần Anh Tuấn (2018). Đặc điểm cắt lớp vi tính ung thư phổi trước điều trị thuốc ức chế Tysosin Kinase và đánh giá đáp ứng theo tiêu chuẩn Recist 1.1. Tạp chí yhọc Việt Nam, tập 470(số 2/2018), 138–141.
6. MacMahon H., Naidich D.P., Goo J.M. và cộng sự. (2017). Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology, 284(1), 228–243.
7. Choi C.-M., Kim M.Y., Lee J.C. và cộng sự. (2013). Advanced Lung Adenocarcinoma Harboring a Mutation of the Epidermal Growth Factor Receptor: CT Findings after Tyrosine Kinase Inhibitor Therapy. Radiology, 270(2), 574–582.
8. Park J., Kobayashi Y., Urayama K.Y. và cộng sự. (2016). Imaging Characteristics of Driver Mutations in EGFR, KRAS, and ALK among Treatment-Naïve Patients with Advanced Lung Adenocarcinoma. PLoS One, 11(8).
9. Hasegawa M., Sakai F., Ishikawa R. và cộng sự. (2016). CT Features of Epidermal Growth Factor Receptor– Mutated Adenocarcinoma of the Lung: Comparison with Nonmutated Adenocarcinoma. Journal of Thoracic Oncology, 11(6), 819–826.
10. Winer-Muram H.T. (2006). The solitary pulmonary nodule. Radiology, 239(1), 34–49.
11. Watanabe Y., Kusumoto M., Yoshida A. và cộng sự. (2015). Surgically Resected Solitary Cavitary Lung Adenocarcinoma: Association Between Clinical, Pathologic, and Radiologic Findings and Prognosis. The Annals of Thoracic Surgery, 99(3), 968–974.
12. Enomoto Y., Takada K., Hagiwara E. và cộng sự. (2013). Distinct features of distant metastasis and lymph node stage in lung adenocarcinoma patients with epidermal growth factor receptor gene mutations. Respir Investig, 51(3), 153–157.
13. Nguyễn Minh Hà, Trần Huy Thịnh, Trần Vân Khánh và cộng sự. (2014). Erlotinib bước một trên BN ung thư phổi không tế bào nhỏ giai đoạn muộn có đột biến gen EGFR. Tạp chí nghiên cứu yhọc, Phụ trương 91, 7–14.