杵狀指是一個臨床常見的現象,通常是在肺部或心臟疾病中的病人表現。這種情況並非罕見,可發生在所有細胞類型的肺癌[1]。導致杵狀指的確切機轉還沒有完全理解。在某些研究報告指出,肺癌切除後會看到杵狀指的改善[2]。至於肺癌接受化學治療或放射治療後,杵狀指的改善的報導則相當稀少。我們報告一位肺癌患者的杵狀指,在臨床肺癌對化學及放射治療有反應的同時,也看到杵狀指的改善。一位50歲的男子被診斷出非小細胞肺癌,他的初步症狀是咳嗽有痰持續約2個月。胸部X光顯示,大約有一個9公分的腫瘤在右上肺葉。經細針穿刺胸部的細胞學報告顯示為腺癌。臨床分期為T4N0M0,同時伴隨有縱隔腔的侵襲。杵狀指也同樣明顯。這位患者接受六次的化學治療平均每三週施打一次,紫杉醇180mg/平方公尺和順鉑75 mg/平方公尺,以及放射治療52 Gy。腫瘤治療後顯著縮小。杵狀指同時也改善。病人治療後已追蹤12個月並無復發。
Digital clubbing is a clinically sign that typically indicates pulmonary or cardiac disease. It is not uncommon and can occur in all cell types of lung cancer [1]. The exact mechanism for clubbing is still not fully understood. A reversal of clubbing after resection of the lung cancer has been reported in several publications [2], but improvement in digital clubbing after chemotherapy or radiotherapy is seldom reported. We herein report a lung cancer patient whose clubbing fingers improved simultaneously with the clinical response after chemotherapy and radiotherapy. A 50-year-old man was diagnosed with non-small cell lung cancer and the initial presentation was productive cough for 2 months. Chest radiography showed a mass 9 cm at the right upper lobe. Cytology of the transthoracic needle aspiration revealed adenocarcinoma. The clinical stage was T4N0M0 with mediastinal invasion, using a CT scan. The clubbing fingers were also remarkable. He received 6 courses of chemotherapy with paclitaxel 180 mg/m^2 plus cisplatin 75 mg/m^2 every 3 weeks followed by radiotherapy 52 Gy. The tumor shrank significantly after treatment. The clubbing fingers also improved simultaneously. The patient was followed up for 12 months after treatment without recurrence.