乳癌合併胸壁皮膚轉移病人接受電腦斷層螺旋刀放射治療之照護－病例報告

乳癌的發生率一直為所有癌症之首，易透過淋巴結或血液轉移至其他部位。本案例為一名55歲於2016年4月時診斷罹患兩側侵犯性乳癌的女性病人，已有遠端淋巴結與皮膚的轉移，在胸壁、皮膚及腋下淋巴結出現大範圍腫瘤惡化，組織發生出血與傷口，需透過每天濕敷換藥與營養支持。自2017年11月起，接受Everolimus（Afinitor®，癌伏妥）以及Exemestane（Aromasin®，諾曼癌素）的全身性治療，出血與傷口逐漸癒合。一個月後開始進行化學治療，胸壁及皮膚腫瘤的轉移獲得緩解。於2018年2月接受緩解性（palliative）放射治療。本案例病灶範圍大且形狀不規則，治療區域會受到手臂遮擋影響劑量分佈，因此，採用360度螺旋式強度調控治療，即電腦斷層螺旋刀，提高治療靶區涵蓋範圍，藉此讓胸壁與皮膚的腫瘤達到更好的局部控制。病患雖於治療完五個月後死亡，但於治療期間及治療後可觀察到傷口組織液減少及皮膚表面腫瘤縮小，改善病患生活品質。

關鍵字

乳癌；胸壁皮膚轉移；電腦斷層螺旋刀；放射治療

並列摘要

Breast cancer is the most common cancer in women. It metastasizes to other tissues rapidly through blood and/or lymph nodes. This case of 55 years old female was diagnosed with bilateral invasive breast cancer in April 2016. She had distant lymph nodes, extensive skin and chest wall metastases. She received daily wet dressing and nutrition support for her extensive skin metastases with hemorrhagic wounds. The systemic therapy regimens were transferred to Everolimus (Afinitor® ) and Exemestane (Aromasin® ) since November 2017. Then, the hemorrhagic wounds healed under the intensive treatment. The skin and chest wall metastases were in the relatively stationary disease status disclosed by computed tomography on December 13, 2017. Finally, she was referred for palliative radiotherapy for better local control of the extensive skin lesions and chest wall metastases. The lesions were large and had irregular shape in this case. The treatment isodose distribution would be affected by the ipsilateral arm so we chose Tomotherapy to improve dose uniformity and target coverage for the patient. The woman was deceased five months after radiotherapy treatment but we observed that the tissue fluid from her wounds decreased and her skin lesions became smaller.