放疗联合吉非替尼治疗EGFR敏感突变低级别肺黏液表皮样癌1例报告及文献复习

目的：探讨局部放射疗法（放疗）联合表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKIs）治疗无法手术切除、EGFR敏感突变低级别肺黏液表皮样癌（PMEC）患者的疗效，分析该治疗模式的有效性和安全性，为其临床治疗提供参考。方法：收集1例明确诊断为PMEC患者的临床资料，结合相关文献，分析患者影像学和临床症状的变化与预后的关系。结果：患者，女性，22岁，因胸闷气短、干咳2个月入院。病理诊断为PMEC，基因检测示EGFR基因21号外显子L858R突变，无法手术切除。患者入院后给予吉非替尼250 mg·d^-1口服，同步局部放疗2 Gy/次，25次，共50 Gy。经局部放疗联合口服吉非替尼治疗后，患者病灶较放疗前缩小，持续口服吉非替尼至今，病灶进一步缩小；患者除皮疹外无不良反应，无进展生存期（PFS）已达18个月。结论：对于EGFR敏感突变、不可手术切除的低级别PMEC，放疗联合EGFR-TKIs的治疗模式疗效较好，不良反应可以接受。

Radiotherapy combined with gefitinib in treatment of low-grade pulmonary mucoepidermoid carcinoma with EGFR sensitive mutation: A case report and literature review

Objective: To explore the curative effect of local radiotherapy combined with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in the treatment of the patient with unresectable and low-grade pulmonary mucoepidermal carcinoma (PMEC) with positive EGFR mutation, to analyze the effectiveness and safety of the treatment mode, and to provide the clinical reference for the treatment of this disease. Methods: The clinical data of a patient who diagnosed as PMEC was collected. The relationships between the changes of imaging and clinical symptoms and the prognosis of the patient were analyzed and the relative literatures were reviewed. Results: A 22-year-old woman was admitted to the hospital due to shortness of breath and 2 months of cough.The pathological diagnosis was PMEC,the L858R mutation in exon 21 of EGFR gene was found by gene detection and the tumor could not be resected by surgery.The patient was treated with gefitinib 250 mg·d^-1 orally combined with radiotherapy,and the dose of radiotherapy was 50 Gy totally with 2 Gy per fraction(25 times). After the treatment of local radiotherapy combined with oral administration of gefitinib, the tumor size was shrunk compared with before radiotherapy. The tumor size was shrunk further after the intervention of continuous oral gefitinib;the patient had no adverse reactions except the mild skin rash,and the progression free survival (PFS) was 18 months. Conclusion: For the unresectable and low-grade PMEC patient with positive EGFR mutation, the treatment mode of radiotherapy combined with EGFR-TKIs has good efficacy and the side effects could be accepted.