BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemothe...BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.展开更多
局部晚期头颈部鳞状细胞癌(locally advanced head and neck squamous cell carcinoma,LA-HNSCC)虽经手术、放疗和化疗的综合治疗,疗效仍不尽如人意,40%~60%的患者治疗后会发生局部复发或远处转移,5年生存率不超过50%。近年来免疫检查...局部晚期头颈部鳞状细胞癌(locally advanced head and neck squamous cell carcinoma,LA-HNSCC)虽经手术、放疗和化疗的综合治疗,疗效仍不尽如人意,40%~60%的患者治疗后会发生局部复发或远处转移,5年生存率不超过50%。近年来免疫检查点抑制剂(immune checkpoint inhibitor,ICI)为复发/转移的头颈部鳞癌(recurrent or metastatic head and neck squamous cell carcinoma,R/M HNSCC)患者带来了生存获益,也成为国内外指南的一线推荐。基于免疫检查点抑制剂的安全性与有效性,大量临床研究围绕局部晚期头颈部鳞癌的免疫新辅助治疗策略,包括免疫单药或联合化疗、靶向、放疗等展开深入探讨,以期提高病理缓解率,继而改善总生存率。该文就免疫治疗在局部晚期头颈部鳞癌新辅助的研究现状和进展做一综述,希望对临床决策提供参考。展开更多
文摘BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.
文摘局部晚期头颈部鳞状细胞癌(locally advanced head and neck squamous cell carcinoma,LA-HNSCC)虽经手术、放疗和化疗的综合治疗,疗效仍不尽如人意,40%~60%的患者治疗后会发生局部复发或远处转移,5年生存率不超过50%。近年来免疫检查点抑制剂(immune checkpoint inhibitor,ICI)为复发/转移的头颈部鳞癌(recurrent or metastatic head and neck squamous cell carcinoma,R/M HNSCC)患者带来了生存获益,也成为国内外指南的一线推荐。基于免疫检查点抑制剂的安全性与有效性,大量临床研究围绕局部晚期头颈部鳞癌的免疫新辅助治疗策略,包括免疫单药或联合化疗、靶向、放疗等展开深入探讨,以期提高病理缓解率,继而改善总生存率。该文就免疫治疗在局部晚期头颈部鳞癌新辅助的研究现状和进展做一综述,希望对临床决策提供参考。
