内容紹介
A Case of Intrathecal Infusion of Methotrexate and Ara-C for a Patient with Meningitis Due to Recurrent Gastric Cancer
Summary
A 69-year-old woman underwent total gastrectomy for advanced gastric cancer with pyloric stenosis. She had a good postoperative course and was discharged 2 weeks after surgery. She received adjuvant chemotherapy with S-1 after discharge. One month after the initiation of the adjuvant chemotherapy, she complained of wobbling and weakness of her limbs. She stopped intake of S-1, but the symptoms did not improve. She was admitted to the hospital, but she became unconscious and had headache and blurred vision. We conducted a cerebrospinal fluid examination and made a diagnosis of meningeal carcinomatosis. After we started intrathecal infusion of methotrexate and Ara-C, referring to case reports clinical symptoms, including unconsciousness, headache, and left upper limb paralysis, improved and the CEA level in cerebrospinal fluid decreased.
要旨
症例は69歳,女性。幽門狭窄を伴う胃癌につき胃全摘術施行。術後経過は良好で2週間後に退院した。退院後S-1(100 mg/day)内服による補助化学療法を開始した。補助化学療法開始後1か月ごろから,ふらつきや突発的な四肢の脱力を訴えるようになった。S-1内服を中止したものの症状の改善はなく入院の上,経過観察を行ったが,意識消失,頭痛,両目の霧視など多彩な症状を認めるようになった。腰椎穿刺,髄液検査を行い,癌性髄膜炎と診断した。癌性髄膜炎に髄腔内投与を行った報告例を参考にし,methotrexateおよびAra-Cの髄腔内投与を開始したところ,意識消失発作や頭痛,左上肢の麻痺が改善するとともに髄液中の腫瘍マーカーの低下を認めた。
目次
Summary
A 69-year-old woman underwent total gastrectomy for advanced gastric cancer with pyloric stenosis. She had a good postoperative course and was discharged 2 weeks after surgery. She received adjuvant chemotherapy with S-1 after discharge. One month after the initiation of the adjuvant chemotherapy, she complained of wobbling and weakness of her limbs. She stopped intake of S-1, but the symptoms did not improve. She was admitted to the hospital, but she became unconscious and had headache and blurred vision. We conducted a cerebrospinal fluid examination and made a diagnosis of meningeal carcinomatosis. After we started intrathecal infusion of methotrexate and Ara-C, referring to case reports clinical symptoms, including unconsciousness, headache, and left upper limb paralysis, improved and the CEA level in cerebrospinal fluid decreased.
要旨
症例は69歳,女性。幽門狭窄を伴う胃癌につき胃全摘術施行。術後経過は良好で2週間後に退院した。退院後S-1(100 mg/day)内服による補助化学療法を開始した。補助化学療法開始後1か月ごろから,ふらつきや突発的な四肢の脱力を訴えるようになった。S-1内服を中止したものの症状の改善はなく入院の上,経過観察を行ったが,意識消失,頭痛,両目の霧視など多彩な症状を認めるようになった。腰椎穿刺,髄液検査を行い,癌性髄膜炎と診断した。癌性髄膜炎に髄腔内投与を行った報告例を参考にし,methotrexateおよびAra-Cの髄腔内投与を開始したところ,意識消失発作や頭痛,左上肢の麻痺が改善するとともに髄液中の腫瘍マーカーの低下を認めた。