内容紹介
A Resected Case of UR-LA Pancreatic Tail Cancer with Aortic Invasion after Chemoradiotherapy
Summary
A 70-year-old male was referred to our hospital because of weight loss and epigastric discomfort. CT showed an irregular-shaped, low-density tumor, 12 cm in diameter in the tail of the pancreas. This tumor widely invaded to the left kidney and to the anterior and left lateral sides of the aorta in spite of no involvement of celiac and superior mesenteric arteries. Moreover, it closely contacted with the stomach and the spleen. EUS-fine-needle aspiration biopsy of the tumor detected adenocarcinoma. Thus, he was diagnosed with UR-LA pancreatic cancer with aortic invasion. He received combination chemotherapy(S-1 plus gemcitabine[GEM])and 50.4 Gy 3-dimensional conformal radiation therapy, but this therapy had no expected effect. We changed the regimen to GEM plus nab-PTX. After 1 course of changed regimen, the tumor ruptured into the stomach and endoscopic debridement of the necrotic tissue was performed. Twenty-six days later, We performed distal pancreatectomy with splenectomy, total gastrectomy, left nephrectomy, left adrenalectomy, and segmental resection of the colon. The tumor was detached from the aorta as much as possible. The final diagnosis was pT3N0M0, pStageⅡA. Fifty-nine days after operation, we restarted GEM plus nab-PTX therapy. However, a cerebral infarction suddenly occurred, and we discontinued the chemotherapy. Five months after the operation, he died of cancerous peritonitis.
要旨
症例は70歳,男性。体重減少と心窩部違和感を主訴に当院を紹介された。CTでは膵尾部に径12 cm大の不整形,低濃度腫瘤が認められ,左腎に広範に浸潤していた。腹腔動脈および上腸間膜動脈浸潤はなかったが,腫瘍浸潤は大動脈前面～左側壁に及んでいた。また胃,脾臓に近接していた。EUS-FNAで腺癌が検出され,大動脈浸潤を伴うUR-LA膵尾部癌と診断。まずS-1+gemcitabine(GEM)+三次元原体照射50.4 Gyによる化学放射線療法を施行した。しかし効果に乏しく,GEM+nab-PTXを2コース追加することとした。しかし,1コース終了後に腫瘍の胃穿破を来したため,内視鏡下にdebridementを行った。debridement 26日後に脾合併膵体尾部切除,胃全摘,左腎・副腎切除,結腸部分切除を施行した。大動脈浸潤部は可及的に切除した。最終診断はpT3N0M0,pStageⅡAであった。術後59日目からGEM+nab-PTX投与を再開したが,71日目に突然多発脳梗塞を発症し,休薬を余儀なくされた。術後5か月,癌性腹膜炎にて死亡した。
目次
Summary
A 70-year-old male was referred to our hospital because of weight loss and epigastric discomfort. CT showed an irregular-shaped, low-density tumor, 12 cm in diameter in the tail of the pancreas. This tumor widely invaded to the left kidney and to the anterior and left lateral sides of the aorta in spite of no involvement of celiac and superior mesenteric arteries. Moreover, it closely contacted with the stomach and the spleen. EUS-fine-needle aspiration biopsy of the tumor detected adenocarcinoma. Thus, he was diagnosed with UR-LA pancreatic cancer with aortic invasion. He received combination chemotherapy(S-1 plus gemcitabine[GEM])and 50.4 Gy 3-dimensional conformal radiation therapy, but this therapy had no expected effect. We changed the regimen to GEM plus nab-PTX. After 1 course of changed regimen, the tumor ruptured into the stomach and endoscopic debridement of the necrotic tissue was performed. Twenty-six days later, We performed distal pancreatectomy with splenectomy, total gastrectomy, left nephrectomy, left adrenalectomy, and segmental resection of the colon. The tumor was detached from the aorta as much as possible. The final diagnosis was pT3N0M0, pStageⅡA. Fifty-nine days after operation, we restarted GEM plus nab-PTX therapy. However, a cerebral infarction suddenly occurred, and we discontinued the chemotherapy. Five months after the operation, he died of cancerous peritonitis.
要旨
症例は70歳,男性。体重減少と心窩部違和感を主訴に当院を紹介された。CTでは膵尾部に径12 cm大の不整形,低濃度腫瘤が認められ,左腎に広範に浸潤していた。腹腔動脈および上腸間膜動脈浸潤はなかったが,腫瘍浸潤は大動脈前面～左側壁に及んでいた。また胃,脾臓に近接していた。EUS-FNAで腺癌が検出され,大動脈浸潤を伴うUR-LA膵尾部癌と診断。まずS-1+gemcitabine(GEM)+三次元原体照射50.4 Gyによる化学放射線療法を施行した。しかし効果に乏しく,GEM+nab-PTXを2コース追加することとした。しかし,1コース終了後に腫瘍の胃穿破を来したため,内視鏡下にdebridementを行った。debridement 26日後に脾合併膵体尾部切除,胃全摘,左腎・副腎切除,結腸部分切除を施行した。大動脈浸潤部は可及的に切除した。最終診断はpT3N0M0,pStageⅡAであった。術後59日目からGEM+nab-PTX投与を再開したが,71日目に突然多発脳梗塞を発症し,休薬を余儀なくされた。術後5か月,癌性腹膜炎にて死亡した。