内容紹介
Local Control by Mastectomy in Advanced Breast Cancer with Liver Metastasis after Chemotherapy, Radiotherapy, and Hyperthermia―A Case Report
Summary
Advanced breast cancer has a poor prognosis compared to early breast cancer; however, quality of life and radical operation can be improved in some case by using multidisciplinary treatment. A 54-year-old woman was examined at the hospital because of an enlarging tumor in the left breast. She was aware of a lump for 3 years. Results of the initial examination indicated invasive ductal carcinoma with liver metastasis. She first received chemotherapy(AC followed by weekly paclitaxel). After 4 courses of weekly paclitaxel, computed tomography revealed axillary lymph nodes involved in the axillary vein. Operation was difficult and conversion therapy was administered. The patient underwent radiotherapy, hyperthermia, and hormone therapy. After 1 year from the start of hormone therapy, the metastasis had disappeared and the patient underwent operation in our unit. Eight months after operation, no recurrence was observed.
要旨
初診時に局所進行・肝転移を伴う乳癌患者に対し,薬物・放射線・温熱療法を施行した後に手術をし得た1例を経験したので報告する。症例は54歳,女性。左乳腺全体に広がる腫瘤と一部壊死を伴う巨大な腋窩腫瘤が一塊となっており,初診時の全身検査で肝転移を認めcStage Ⅳ乳癌と診断した。治療として,化学療法(AC followed by weekly paclitaxel)を施行,効果判定のCTにて腋窩リンパ節が腋窩静脈に浸潤している可能性があり,手術困難と判断し放射線治療30 Gy/15回を施行した。同時に温熱療法,アロマターゼ阻害剤を開始した。内分泌療法開始後,約1年経過時でのPET検査にて肝転移の消失と腋窩リンパ節の縮小を認め,局所制御目的に手術(Bt+Ax)を施行した。現在,アロマターゼ阻害剤の内服を再開し経過観察中である。疼痛や滲出液汚染などでQOLが低下している状況で,手術困難な症例でも集学的治療により手術をし得る場合があると考える。
目次
Summary
Advanced breast cancer has a poor prognosis compared to early breast cancer; however, quality of life and radical operation can be improved in some case by using multidisciplinary treatment. A 54-year-old woman was examined at the hospital because of an enlarging tumor in the left breast. She was aware of a lump for 3 years. Results of the initial examination indicated invasive ductal carcinoma with liver metastasis. She first received chemotherapy(AC followed by weekly paclitaxel). After 4 courses of weekly paclitaxel, computed tomography revealed axillary lymph nodes involved in the axillary vein. Operation was difficult and conversion therapy was administered. The patient underwent radiotherapy, hyperthermia, and hormone therapy. After 1 year from the start of hormone therapy, the metastasis had disappeared and the patient underwent operation in our unit. Eight months after operation, no recurrence was observed.
要旨
初診時に局所進行・肝転移を伴う乳癌患者に対し,薬物・放射線・温熱療法を施行した後に手術をし得た1例を経験したので報告する。症例は54歳,女性。左乳腺全体に広がる腫瘤と一部壊死を伴う巨大な腋窩腫瘤が一塊となっており,初診時の全身検査で肝転移を認めcStage Ⅳ乳癌と診断した。治療として,化学療法(AC followed by weekly paclitaxel)を施行,効果判定のCTにて腋窩リンパ節が腋窩静脈に浸潤している可能性があり,手術困難と判断し放射線治療30 Gy/15回を施行した。同時に温熱療法,アロマターゼ阻害剤を開始した。内分泌療法開始後,約1年経過時でのPET検査にて肝転移の消失と腋窩リンパ節の縮小を認め,局所制御目的に手術(Bt+Ax)を施行した。現在,アロマターゼ阻害剤の内服を再開し経過観察中である。疼痛や滲出液汚染などでQOLが低下している状況で,手術困難な症例でも集学的治療により手術をし得る場合があると考える。