セツキシマブ併用放射線治療中の誤嚥から生じた急性呼吸促迫症候群例

抄録

Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, however, mortality from this disease remains as high as 30–40%.
A 5X-year-old man presented to the ENT service with a 3-month history of discomfort in the pharynx. Based on the findings of endoscopy and positron emission tomography/computed tomography (PET/CT), the patient was diagnosed as having oropharyngeal carcinoma (T4aN2cM0). Two cycles of TPF chemotherapy (docetaxel, cisplatin and 5-fluorouracil) were administered, which led to no reduction of the tumor size. Therefore, radiotherapy was combined with administration of cetuximab (bioradiotherapy: BRT).
BRT was associated with an enhanced severity of mucositis, resulting in aspiration. The respiratory function deteriorated gradually, and eventually, the patient was diagnosed as having ARDS. Artificial non-­invasive positive pressure ventilation (NPPV) was initiated, along with administration of neutrophil elastase inhibitor (sivelestat) and methylprednisolone (1 mg/kg). In response to the treatment, the respiratory function gradually improved and the patient could be weaned off NPPV on the 14th day.