内容紹介
A Resectable Case of TS-1 Therapy Useful in Distinguishing Primary Lung Cancer from Lung Metastases of Pancreatic Cancer
Summary
We report a case of pneumonectomy followed by radical pancreatectomy after oral administration of TS-1 for pancreatic cancer with complications of a lung tumor. The patient was a 66-year-old woman. A pancreatic tail tumor and 2 lung nodules were detected on CT scans, and were diagnosed as pancreatic cancer and metastatic lung cancer. During a total of 11 courses of TS-1 therapy, the pancreatic tumor tended to contract, but both pulmonary nodules remained unchanged. Due to differences in treatment effect, double cancers of the lung and pancreas were suspected, rather than metastatic lung cancers. We performed a VATS partial resection of the left lower lobe for diagnostic therapy. The pathological diagnosis revealed an inflammatory myofibroblastic tumor and a primary lung cancer. We diagnosed that a radical pancreatectomy was possible and performed distal pancreatectomy. Pathological diagnosis confirmed an invasive pancreatic ductal carcinoma. Oral administration of TS-1 was performed as adjuvant chemotherapy after surgery. Liver metastasis was observed 10 months after pancreatectomy, and GEM therapy was initiated. Peritoneal dissemination was observed at 2 years following pancreatectomy, and the patient died at 2 years and 9 months. TS-1 therapy for synchronous lung tumors and pancreatic cancer with careful observation allowed for a definitive radical resection. This method was an effective treatment for lung nodules with pancreatic cancer.
要旨
肺腫瘍を併発した膵癌に対してTS-1内服後に肺切除を行い,根治的膵切除を行った症例を経験したので報告する。症例は66歳,女性。CTで膵尾部腫瘤と2か所の肺結節を認め,膵癌および転移性肺癌と診断した。TS-1療法を計11コース施行し膵腫瘍は縮小傾向であったが,肺結節はともに不変であった。治療効果の違いから原発性肺癌の重複癌を疑い,診断的治療目的に胸腔鏡下左肺下葉部分切除術を施行した。病理診断は炎症性筋線維芽細胞性腫瘍および原発性肺癌であった。根治的膵切除が可能と考え,膵体尾部切除術を施行した。病理診断は浸潤性膵管癌であった。術後補助化学療法としてTS-1内服を行った。膵切除後10か月で肝転移を認め,GEM療法を開始した。膵切除後2年で腹膜播種を認め,2年9か月で死亡した。膵癌の同時性肺腫瘍に対し,膵癌,肺癌ともに効果のあるTS-1療法を施行することで慎重な経過観察を行うことができ,根治的切除が可能となる症例もあり,有効な治療方針と考えられた。
目次
Summary
We report a case of pneumonectomy followed by radical pancreatectomy after oral administration of TS-1 for pancreatic cancer with complications of a lung tumor. The patient was a 66-year-old woman. A pancreatic tail tumor and 2 lung nodules were detected on CT scans, and were diagnosed as pancreatic cancer and metastatic lung cancer. During a total of 11 courses of TS-1 therapy, the pancreatic tumor tended to contract, but both pulmonary nodules remained unchanged. Due to differences in treatment effect, double cancers of the lung and pancreas were suspected, rather than metastatic lung cancers. We performed a VATS partial resection of the left lower lobe for diagnostic therapy. The pathological diagnosis revealed an inflammatory myofibroblastic tumor and a primary lung cancer. We diagnosed that a radical pancreatectomy was possible and performed distal pancreatectomy. Pathological diagnosis confirmed an invasive pancreatic ductal carcinoma. Oral administration of TS-1 was performed as adjuvant chemotherapy after surgery. Liver metastasis was observed 10 months after pancreatectomy, and GEM therapy was initiated. Peritoneal dissemination was observed at 2 years following pancreatectomy, and the patient died at 2 years and 9 months. TS-1 therapy for synchronous lung tumors and pancreatic cancer with careful observation allowed for a definitive radical resection. This method was an effective treatment for lung nodules with pancreatic cancer.
要旨
肺腫瘍を併発した膵癌に対してTS-1内服後に肺切除を行い,根治的膵切除を行った症例を経験したので報告する。症例は66歳,女性。CTで膵尾部腫瘤と2か所の肺結節を認め,膵癌および転移性肺癌と診断した。TS-1療法を計11コース施行し膵腫瘍は縮小傾向であったが,肺結節はともに不変であった。治療効果の違いから原発性肺癌の重複癌を疑い,診断的治療目的に胸腔鏡下左肺下葉部分切除術を施行した。病理診断は炎症性筋線維芽細胞性腫瘍および原発性肺癌であった。根治的膵切除が可能と考え,膵体尾部切除術を施行した。病理診断は浸潤性膵管癌であった。術後補助化学療法としてTS-1内服を行った。膵切除後10か月で肝転移を認め,GEM療法を開始した。膵切除後2年で腹膜播種を認め,2年9か月で死亡した。膵癌の同時性肺腫瘍に対し,膵癌,肺癌ともに効果のあるTS-1療法を施行することで慎重な経過観察を行うことができ,根治的切除が可能となる症例もあり,有効な治療方針と考えられた。