内容紹介
A Case of Transverse Colon Cancer with Liver Metastasis and Tumor Thrombosis of Portal Vein Effectively Treated with Chemotherapy
Summary
The patient was a 70-year-old man. He was diagnosed with advanced transverse colon cancer. A computed tomography(CT)revealed liver metastasis and tumor thrombosis of portal vein. We started combination chemotherapy with capecitabine/oxaliplatin(CapeOX). Perforation of the tumor was observed 5 days after CapeOX therapy was started. Treatment with abscess drainage and ileostmy, infection was controlled and general condition was improved. After 9 courses of CapeOX, we changed chemotherapy regimen to irinotecan/tegafur-gimeracil-oteracil potassium(IRIS)due to strong side effects. In CT and FDG-PET examination after 8 courses of IRIS, the tumor of transverse colon, liver metastasis, and the tumor thrombosis of portal vein became unclear. A year and 6 months have passed since chemotherapy was started, recurrence was not observed. For the patients with unresectable colorectal cancer, it is necessary to consider multidisciplinary treatments including chemotherapy while considering the general condition of them.
要旨
患者は70歳,男性。横行結腸癌の精査加療目的に当科紹介受診となった。CT検査で肝S6,S8に転移を疑う結節影と門脈腫瘍栓の所見を認めた。手術による治癒切除は困難の判断にて化学療法による治療方針となった。capecitabine/oxaliplatin(CapeOX)療法開始5日目に腫瘍部の穿孔を認め,抗菌剤治療にて症状が改善せず,穿刺膿瘍ドレナージ,回腸人工肛門造設術を施行した。全身状態改善後に化学療法を再開した。CapeOX 9コース施行後,Grade 3の感覚性神経障害(手足のしびれ)の副作用を認め,レジメンをirinotecan/tegafur-gimeracil-oteracil potassium(IRIS)に変更した。IRIS 8コース施行後のCTおよびFDG-PET検査では腫瘍病変は不明瞭となり,門脈塞栓部を含めFDGの異常集積像は認めなかった。化学療法開始後1年6か月後も明らかな病変の再燃は認めず,外来化学療法(IRIS)を継続している。切除不能大腸癌に対しては,全身状態を考慮しながら化学療法を含めた集学的治療を検討することが必要と考える。
目次
Summary
The patient was a 70-year-old man. He was diagnosed with advanced transverse colon cancer. A computed tomography(CT)revealed liver metastasis and tumor thrombosis of portal vein. We started combination chemotherapy with capecitabine/oxaliplatin(CapeOX). Perforation of the tumor was observed 5 days after CapeOX therapy was started. Treatment with abscess drainage and ileostmy, infection was controlled and general condition was improved. After 9 courses of CapeOX, we changed chemotherapy regimen to irinotecan/tegafur-gimeracil-oteracil potassium(IRIS)due to strong side effects. In CT and FDG-PET examination after 8 courses of IRIS, the tumor of transverse colon, liver metastasis, and the tumor thrombosis of portal vein became unclear. A year and 6 months have passed since chemotherapy was started, recurrence was not observed. For the patients with unresectable colorectal cancer, it is necessary to consider multidisciplinary treatments including chemotherapy while considering the general condition of them.
要旨
患者は70歳,男性。横行結腸癌の精査加療目的に当科紹介受診となった。CT検査で肝S6,S8に転移を疑う結節影と門脈腫瘍栓の所見を認めた。手術による治癒切除は困難の判断にて化学療法による治療方針となった。capecitabine/oxaliplatin(CapeOX)療法開始5日目に腫瘍部の穿孔を認め,抗菌剤治療にて症状が改善せず,穿刺膿瘍ドレナージ,回腸人工肛門造設術を施行した。全身状態改善後に化学療法を再開した。CapeOX 9コース施行後,Grade 3の感覚性神経障害(手足のしびれ)の副作用を認め,レジメンをirinotecan/tegafur-gimeracil-oteracil potassium(IRIS)に変更した。IRIS 8コース施行後のCTおよびFDG-PET検査では腫瘍病変は不明瞭となり,門脈塞栓部を含めFDGの異常集積像は認めなかった。化学療法開始後1年6か月後も明らかな病変の再燃は認めず,外来化学療法(IRIS)を継続している。切除不能大腸癌に対しては,全身状態を考慮しながら化学療法を含めた集学的治療を検討することが必要と考える。