内容紹介
A Case of Meningeal Carcinomatosis and Small Cell Lung Carcinoma Effectively Treated Using a Multidisciplinary Approach
Summary
A 65-year-old man visited our hospital with dyspnea and cough. He was diagnosed with small cell lung carcinoma(cT4N2M1b, StageⅣ). The disease partially responded to systemic chemotherapy. However, it was progressive and metastasized to the brain 3 months after 6 courses of chemotherapy. Therefore, whole brain irradiation was performed. Subsequently, weakness of the lower extremities and vesicorectal disturbances appeared. Meningeal carcinomatosis was diagnosed by enhanced magnetic resonance imaging and liquid examination. Methotrexate plus cytarabine plus dexamethasone was injected intrathecally and spinal irradiation was performed. An Ommaya reservoir was placed and intrathecal chemotherapy was continued. Systemic chemotherapy was also administered. Consequently, his symptoms improved and he was successfully discharged. Therefore, a multidisciplinary approach should be considered to improve the symptoms of patients with meningeal carcinomatosis.
要旨
症例は65歳,男性。小細胞肺癌,cT4N2M1b,StageⅣ(肝転移,膵転移)と診断された。化学療法にて部分奏効が得られていたが,経過観察中に脳転移が出現し全脳照射を行った。その後,下肢脱力と膀胱直腸障害が出現し,髄液検査より髄膜癌腫症と診断した。メトトレキサート+シタラビン+デキサメタゾンの髄注と全脊髄放射線照射を行った後,オンマイヤーリザーバーを留置して抗癌剤の髄注を継続した。全身化学療法を併用し,リハビリテーションも施行し,症状は改善して退院可能となった。髄膜癌腫症に対して集学的アプローチが有効であったと考えられた。
目次
Summary
A 65-year-old man visited our hospital with dyspnea and cough. He was diagnosed with small cell lung carcinoma(cT4N2M1b, StageⅣ). The disease partially responded to systemic chemotherapy. However, it was progressive and metastasized to the brain 3 months after 6 courses of chemotherapy. Therefore, whole brain irradiation was performed. Subsequently, weakness of the lower extremities and vesicorectal disturbances appeared. Meningeal carcinomatosis was diagnosed by enhanced magnetic resonance imaging and liquid examination. Methotrexate plus cytarabine plus dexamethasone was injected intrathecally and spinal irradiation was performed. An Ommaya reservoir was placed and intrathecal chemotherapy was continued. Systemic chemotherapy was also administered. Consequently, his symptoms improved and he was successfully discharged. Therefore, a multidisciplinary approach should be considered to improve the symptoms of patients with meningeal carcinomatosis.
要旨
症例は65歳,男性。小細胞肺癌,cT4N2M1b,StageⅣ(肝転移,膵転移)と診断された。化学療法にて部分奏効が得られていたが,経過観察中に脳転移が出現し全脳照射を行った。その後,下肢脱力と膀胱直腸障害が出現し,髄液検査より髄膜癌腫症と診断した。メトトレキサート+シタラビン+デキサメタゾンの髄注と全脊髄放射線照射を行った後,オンマイヤーリザーバーを留置して抗癌剤の髄注を継続した。全身化学療法を併用し,リハビリテーションも施行し,症状は改善して退院可能となった。髄膜癌腫症に対して集学的アプローチが有効であったと考えられた。