内容紹介
A Case of Advanced Breast Cancer with Liver Metastasis Successfully Treated with Multi-Disciplinary
Summary
We report a case of advanced breast cancer with liver metastasis(T2N1M1, Stage Ⅳ)achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was 37-year-old woman who had breast lump and axillary lymph nodes swelling with liver metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, negative for estrogen receptor and progesterone receptor, and positive for HER2/neu protein expression. The Ki-67 positive cell index was 40%. She received 16 courses of DOC plus HER plus PER(docetaxel 75 mg/m2, trastuzumab 6 mg/kg, pertuzumab 450 mg/body, and received 4 courses of EC(epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2). The breast lesion and liver metastatic lesion disappeared after chemotherapy. We checked up whole body. There was no metastatic lesion. Therefore, we diagnosed a clinical complete response. We performed muscle preserving mastectomy and axillary lymph nodes dissection. The pathological diagnosis from resected specimens were pathological complete response. The surgical margin was negative. She was started the endocrine therapy by tamoxifen(20 mg/day). Three years after surgery, she was well without metastases. Multi-disciplinary therapy can improve patient QOL and the clinical outcomes in Stage Ⅳ advanced breast cancer.
要旨
遠隔転移を有する乳癌に対して化学療法後に原発巣切除を行った症例を経験した。症例は37歳,女性。右乳房腫瘤を触知したため当科を受診した。乳房超音波検査では右AC領域に辺縁不整,境界不明瞭な低エコー腫瘤として描出された。また,同側腋窩リンパ節に転移と思われる腫大を認めた。針生検術を施行したところ,浸潤性乳管癌,ER陰性,PgR陰性,HER2陽性,Ki-67 40%と診断された。全身検索で肝臓に転移を認めた。T2N1M1,Stage Ⅳの診断で,DOC+HER+PER療法(docetaxel 75 mg/m2,trastuzumab 6 mg/kg,pertuzumab 450 mg/body)を16コース,EC療法(epirubicin 90 mg/m2,cyclophosphamide 600 mg/m2)を4コース施行したところ肝転移は消失し,原発巣もcCRとなったため胸筋温存乳房切除術+腋窩リンパ節郭清術(Level Ⅲ)を施行した。病理組織診断ではpCRと診断された。術後経過は良好であり,tamoxifenの投与を行いながら経過を観察している。術後3年目の現在,再発・転移を認めていない。
目次
Summary
We report a case of advanced breast cancer with liver metastasis(T2N1M1, Stage Ⅳ)achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was 37-year-old woman who had breast lump and axillary lymph nodes swelling with liver metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, negative for estrogen receptor and progesterone receptor, and positive for HER2/neu protein expression. The Ki-67 positive cell index was 40%. She received 16 courses of DOC plus HER plus PER(docetaxel 75 mg/m2, trastuzumab 6 mg/kg, pertuzumab 450 mg/body, and received 4 courses of EC(epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2). The breast lesion and liver metastatic lesion disappeared after chemotherapy. We checked up whole body. There was no metastatic lesion. Therefore, we diagnosed a clinical complete response. We performed muscle preserving mastectomy and axillary lymph nodes dissection. The pathological diagnosis from resected specimens were pathological complete response. The surgical margin was negative. She was started the endocrine therapy by tamoxifen(20 mg/day). Three years after surgery, she was well without metastases. Multi-disciplinary therapy can improve patient QOL and the clinical outcomes in Stage Ⅳ advanced breast cancer.
要旨
遠隔転移を有する乳癌に対して化学療法後に原発巣切除を行った症例を経験した。症例は37歳,女性。右乳房腫瘤を触知したため当科を受診した。乳房超音波検査では右AC領域に辺縁不整,境界不明瞭な低エコー腫瘤として描出された。また,同側腋窩リンパ節に転移と思われる腫大を認めた。針生検術を施行したところ,浸潤性乳管癌,ER陰性,PgR陰性,HER2陽性,Ki-67 40%と診断された。全身検索で肝臓に転移を認めた。T2N1M1,Stage Ⅳの診断で,DOC+HER+PER療法(docetaxel 75 mg/m2,trastuzumab 6 mg/kg,pertuzumab 450 mg/body)を16コース,EC療法(epirubicin 90 mg/m2,cyclophosphamide 600 mg/m2)を4コース施行したところ肝転移は消失し,原発巣もcCRとなったため胸筋温存乳房切除術+腋窩リンパ節郭清術(Level Ⅲ)を施行した。病理組織診断ではpCRと診断された。術後経過は良好であり,tamoxifenの投与を行いながら経過を観察している。術後3年目の現在,再発・転移を認めていない。