内容紹介
Brain Metastasis of Triple Negative Breast Cancer after Pathological Complete Response to Neoadjuvant Chemotherapy―A Case Report
Summary
We report the case of a patient with triple negative breast cancer(TNBC)who showed isolated brain metastasis relatively soon after pathological complete response(pCR)to neoadjuvant chemotherapy. A 45-year-old woman with a diagnosis of TNBC(T2N1M0, StageⅡB)received neoadjuvant chemotherapy with 5-FU/epirubicin/cyclophosphamide(FEC), followed by docetaxel. After the neoadjuvant chemotherapy, she underwent mastectomy and axillary lymph node dissection. Histological examination of the resected specimens revealed pCR. Brain metastasis, however, developed 7 months after the resection. She underwent total removal of the brain tumor and 50 Gy irradiation to the right frontal lobe. Histological examination confirmed a diagnosis of metastasis from TNBC. She is doing well with no evidence of disease 81 months after resection of the brain metastasis. This case and a review of the literature suggest that the clinician should be aware that brain metastasis from breast cancer may develop even after achieving pCR to neoadjuvant chemotherapy. Surgical resection followed by radiotherapy may provide a survival benefit for selected patients with isolated brain metastasis from breast cancer.
要旨
症例は45歳,女性。右乳房AC領域,トリプルネガティブ乳癌(TNBC),T2N1M0,StageⅡBの診断に対し,術前化学療法として5-FU/epirubicin/cyclophosphamide(FEC)療法とドセタキセル療法を施行後,乳房切除術と腋窩郭清術を施行した。切除標本の病理学的検索では乳管内病変・リンパ節も含め腫瘍細胞を認めず,病理学的完全奏効(pCR)と判定した。術後補助療法は行わず経過観察中,術後7か月目に右前頭葉に広範な浮腫を伴う22 mm大の転移巣を認め,腫瘍摘出術を施行した。切除標本の病理組織検査でTNBCの転移と診断された。術後,右前頭葉腫瘍床へ50 Gy/25回の放射線療法を行った。脳転移術後6年9か月が経過した現在,新出病変を認めず無再発経過観察中である。術前化学療法でpCRが得られた場合でも,術後早期に脳転移を来す可能性を念頭に置く必要がある。局所制御可能な脳転移巣に対して手術や放射線療法を行うことで,長期生存が期待できる症例も存在する。
目次
Summary
We report the case of a patient with triple negative breast cancer(TNBC)who showed isolated brain metastasis relatively soon after pathological complete response(pCR)to neoadjuvant chemotherapy. A 45-year-old woman with a diagnosis of TNBC(T2N1M0, StageⅡB)received neoadjuvant chemotherapy with 5-FU/epirubicin/cyclophosphamide(FEC), followed by docetaxel. After the neoadjuvant chemotherapy, she underwent mastectomy and axillary lymph node dissection. Histological examination of the resected specimens revealed pCR. Brain metastasis, however, developed 7 months after the resection. She underwent total removal of the brain tumor and 50 Gy irradiation to the right frontal lobe. Histological examination confirmed a diagnosis of metastasis from TNBC. She is doing well with no evidence of disease 81 months after resection of the brain metastasis. This case and a review of the literature suggest that the clinician should be aware that brain metastasis from breast cancer may develop even after achieving pCR to neoadjuvant chemotherapy. Surgical resection followed by radiotherapy may provide a survival benefit for selected patients with isolated brain metastasis from breast cancer.
要旨
症例は45歳,女性。右乳房AC領域,トリプルネガティブ乳癌(TNBC),T2N1M0,StageⅡBの診断に対し,術前化学療法として5-FU/epirubicin/cyclophosphamide(FEC)療法とドセタキセル療法を施行後,乳房切除術と腋窩郭清術を施行した。切除標本の病理学的検索では乳管内病変・リンパ節も含め腫瘍細胞を認めず,病理学的完全奏効(pCR)と判定した。術後補助療法は行わず経過観察中,術後7か月目に右前頭葉に広範な浮腫を伴う22 mm大の転移巣を認め,腫瘍摘出術を施行した。切除標本の病理組織検査でTNBCの転移と診断された。術後,右前頭葉腫瘍床へ50 Gy/25回の放射線療法を行った。脳転移術後6年9か月が経過した現在,新出病変を認めず無再発経過観察中である。術前化学療法でpCRが得られた場合でも,術後早期に脳転移を来す可能性を念頭に置く必要がある。局所制御可能な脳転移巣に対して手術や放射線療法を行うことで,長期生存が期待できる症例も存在する。