内容紹介
Multiple Salvage Radiotherapies for Metachronous Lymph Node Metastasis from Gastric Cancer Contributed to Long-Term Management of Disease
Summary
A 70-year-old man who underwent gastrectomy for StageⅢC gastric cancer developed lymph node(LN)metastasis posterior to the pancreatic head 3 years after the radical surgery. He was first treated with radiotherapy(RT)followed by chemotherapy. The irradiated tumor regressed completely. However, the cancer relapsed in a single para-aortic LN and he was treated with RT to the lesion followed by chemotherapy. Although it completely regressed, later, lung metastasis was observed. The lung lesions were well suppressed by switching to docetaxel; however, the cancer relapsed again in a mediastinal LN, and it was not responsive to docetaxel. The growing mediastinal lesion was irradiated again, which resulted in stable disease. The patient has been treated for 4 years and 7 months with all lesions being well-managed, and chemotherapy is being continued. Recurrent gastric cancer after surgery tends to present as multiple lesions; therefore, the principle therapy is systemic chemotherapy and RT is unlikely to be suitable. However, especially in cases of a solitary lesion that is chemo-resistant, RT could be an optimal option and contribute to long-term survival even in patients with recurrent gastric cancer.
要旨
胃癌術後再発に対しての第一選択は化学療法であるが,胃癌術後複数箇所のリンパ節転移に対して,3回の放射線療法(radio therapy: RT)により長期の病勢制御が可能であった症例を経験したので報告する。症例は70歳,男性。胃癌に対して幽門側胃切除を行い,StageⅢCであった。S-1の補助化学療法を行ったが,3年経過後に膵頭後部リンパ節再発を来した。他に再発病巣なくRTを行い,奏効が得られた。その後,化学療法中に出現した腹部大動脈周囲リンパ節,縦隔リンパ節再発に対してもそれぞれRTを施行し,再発から4年7か月間,化学療法抵抗性であった再発病巣は良好に制御されている。胃癌術後再発におけるRTは,その多くが多発病巣を呈するため適応にはなりにくく,胃周辺臓器への有害事象も考慮する必要があるが,本症例のような化学療法抵抗性の単発病変再発の局所制御には有効性を発揮することがあり,治療の選択肢として重要である。
目次
Summary
A 70-year-old man who underwent gastrectomy for StageⅢC gastric cancer developed lymph node(LN)metastasis posterior to the pancreatic head 3 years after the radical surgery. He was first treated with radiotherapy(RT)followed by chemotherapy. The irradiated tumor regressed completely. However, the cancer relapsed in a single para-aortic LN and he was treated with RT to the lesion followed by chemotherapy. Although it completely regressed, later, lung metastasis was observed. The lung lesions were well suppressed by switching to docetaxel; however, the cancer relapsed again in a mediastinal LN, and it was not responsive to docetaxel. The growing mediastinal lesion was irradiated again, which resulted in stable disease. The patient has been treated for 4 years and 7 months with all lesions being well-managed, and chemotherapy is being continued. Recurrent gastric cancer after surgery tends to present as multiple lesions; therefore, the principle therapy is systemic chemotherapy and RT is unlikely to be suitable. However, especially in cases of a solitary lesion that is chemo-resistant, RT could be an optimal option and contribute to long-term survival even in patients with recurrent gastric cancer.
要旨
胃癌術後再発に対しての第一選択は化学療法であるが,胃癌術後複数箇所のリンパ節転移に対して,3回の放射線療法(radio therapy: RT)により長期の病勢制御が可能であった症例を経験したので報告する。症例は70歳,男性。胃癌に対して幽門側胃切除を行い,StageⅢCであった。S-1の補助化学療法を行ったが,3年経過後に膵頭後部リンパ節再発を来した。他に再発病巣なくRTを行い,奏効が得られた。その後,化学療法中に出現した腹部大動脈周囲リンパ節,縦隔リンパ節再発に対してもそれぞれRTを施行し,再発から4年7か月間,化学療法抵抗性であった再発病巣は良好に制御されている。胃癌術後再発におけるRTは,その多くが多発病巣を呈するため適応にはなりにくく,胃周辺臓器への有害事象も考慮する必要があるが,本症例のような化学療法抵抗性の単発病変再発の局所制御には有効性を発揮することがあり,治療の選択肢として重要である。