内容紹介
Three Cases of Long-Term Surviving Stage Ⅳ Gastric Cancer after Conversion Surgery
Summary
The standard therapy for Stage Ⅳ gastric cancer is chemotherapy. It is not certain, but conversion surgery is expected to be effective. We report the cases of 3 patients who achieved long-term survival after conversion surgery. Case 1 was of a 59-year-old woman. The tumor was classified as L-Less Post, Type 2, tub1, cT3N2M1(#16a2lat), Stage Ⅳ. Then, we initiated S-1 plus cisplatin and the LN achieved PR after 4 courses. We performed distal gastrectomy with D2 lymph node dissection in February 2011. It was classified as ypT2N2 and the primary lesion was histologically classified as Grade 1a. Case 2 was of a 74-year-old man. The tumor was classified as UM-Less Ant, Type 3, por1, cT3N2H0P1CY1, Stage Ⅳ. Then, we initiated docetaxel plus cisplatin plus S-1 and the primary tumor achieved PR after 6 courses. There were no new tumors and we conducted a laparoscopic examination. After the decision of P0CY0, we performed total gastrectomy with D2 lymph node dissection in April 2012. It was classified as ypT3N1 and the primary lesion was histologically classified as Grade 2. Case 3 was of a 64-year-old woman. The tumor was classified as UM-Less, Type 3, por1, cT3N2H1M0(liver), Stage Ⅳ. Then, we initiated capecitabin plus cisplatin and liver metastasis achieved PR after 6 courses. We performed total gastrectomy with D2 lymph node dissection in July 2012. It was classified as ypT3N1 and the primary lesion was histologically classified as Grade 1b. All postoperative chemotherapy courses were of only S-1. In case 1, the para aortic LN exhibited recurrence 6 months postoperatively. We initiated weekly paclitaxel as second-line therapy. It achieved CR after 6 courses, and the same trend was maintained. In cases 2 and 3, no therapy was administered after 8 S-1 courses, but no recurrences occurred. All patients survived after 62-77 months postoperatively. A new clinical trial is needed to prove the improvement in prognosis for Stage Ⅳ gastric cancer after conversion surgery.
要旨
Stage Ⅳ胃癌に対する標準治療は全身化学療法である。化学療法奏効例に対して原発巣切除を行うconversion surgeryは有望視されているが,まだ標準治療として確立はされていない。Stage Ⅳ胃癌に対してconversion surgeryを施行し,長期生存を得た3例を経験したので報告する。症例1は59歳,女性。L-Less Post領域のType 2の腺癌(tub1),cT3N2M1(#16a2lat),Stage Ⅳの診断でS-1+cisplatin療法4コース後にリンパ節がPRとなったため,2011年2月幽門側胃切除・D2郭清を施行した。ypT2N2組織学的効果判定はGrade 1aであった。症例2は74歳,男性。UM-Less Ant領域のType 3の腺癌(por1)で審査腹腔鏡を行い,cT3N2H0P1CY1,Stage Ⅳの診断でdocetaxel+cisplatin+S-1療法6コースでリンパ節移転はPR,新規病変の出現がないため審査腹腔鏡を行い,P0CY0を確認後に2012年4月胃全摘・D2郭清を施行した。ypT3N1,組織学的効果判定はGrade 2であった。症例3は64歳,女性。UM-LessのType 3の腺癌(por1)でcT3N2H1M0(liver),Stage Ⅳの診断でcapecitabine+cisplatin療法6コース後に肝転移PRとなり,2012年7月胃全摘・D2郭清を施行した。ypT3N1,組織学的効果判定はGrade 1bであった。全例で術後補助療法としてS-1単剤の投与を開始した。症例1は術後6か月で傍大動脈リンパ節再発が出現し,second-line治療としてweekly paclitaxel療法を開始した。6コースでCRとなり,以後継続中である。症例2,3はS-1を8コース終了後は無治療であるが無再発である。術後62～77か月経過し,全例が生存中である。Stage Ⅳ胃癌に対するconversion surgeryが予後の改善につながるか新たな臨床試験が必要と思われる。
目次
Summary
The standard therapy for Stage Ⅳ gastric cancer is chemotherapy. It is not certain, but conversion surgery is expected to be effective. We report the cases of 3 patients who achieved long-term survival after conversion surgery. Case 1 was of a 59-year-old woman. The tumor was classified as L-Less Post, Type 2, tub1, cT3N2M1(#16a2lat), Stage Ⅳ. Then, we initiated S-1 plus cisplatin and the LN achieved PR after 4 courses. We performed distal gastrectomy with D2 lymph node dissection in February 2011. It was classified as ypT2N2 and the primary lesion was histologically classified as Grade 1a. Case 2 was of a 74-year-old man. The tumor was classified as UM-Less Ant, Type 3, por1, cT3N2H0P1CY1, Stage Ⅳ. Then, we initiated docetaxel plus cisplatin plus S-1 and the primary tumor achieved PR after 6 courses. There were no new tumors and we conducted a laparoscopic examination. After the decision of P0CY0, we performed total gastrectomy with D2 lymph node dissection in April 2012. It was classified as ypT3N1 and the primary lesion was histologically classified as Grade 2. Case 3 was of a 64-year-old woman. The tumor was classified as UM-Less, Type 3, por1, cT3N2H1M0(liver), Stage Ⅳ. Then, we initiated capecitabin plus cisplatin and liver metastasis achieved PR after 6 courses. We performed total gastrectomy with D2 lymph node dissection in July 2012. It was classified as ypT3N1 and the primary lesion was histologically classified as Grade 1b. All postoperative chemotherapy courses were of only S-1. In case 1, the para aortic LN exhibited recurrence 6 months postoperatively. We initiated weekly paclitaxel as second-line therapy. It achieved CR after 6 courses, and the same trend was maintained. In cases 2 and 3, no therapy was administered after 8 S-1 courses, but no recurrences occurred. All patients survived after 62-77 months postoperatively. A new clinical trial is needed to prove the improvement in prognosis for Stage Ⅳ gastric cancer after conversion surgery.
要旨
Stage Ⅳ胃癌に対する標準治療は全身化学療法である。化学療法奏効例に対して原発巣切除を行うconversion surgeryは有望視されているが,まだ標準治療として確立はされていない。Stage Ⅳ胃癌に対してconversion surgeryを施行し,長期生存を得た3例を経験したので報告する。症例1は59歳,女性。L-Less Post領域のType 2の腺癌(tub1),cT3N2M1(#16a2lat),Stage Ⅳの診断でS-1+cisplatin療法4コース後にリンパ節がPRとなったため,2011年2月幽門側胃切除・D2郭清を施行した。ypT2N2組織学的効果判定はGrade 1aであった。症例2は74歳,男性。UM-Less Ant領域のType 3の腺癌(por1)で審査腹腔鏡を行い,cT3N2H0P1CY1,Stage Ⅳの診断でdocetaxel+cisplatin+S-1療法6コースでリンパ節移転はPR,新規病変の出現がないため審査腹腔鏡を行い,P0CY0を確認後に2012年4月胃全摘・D2郭清を施行した。ypT3N1,組織学的効果判定はGrade 2であった。症例3は64歳,女性。UM-LessのType 3の腺癌(por1)でcT3N2H1M0(liver),Stage Ⅳの診断でcapecitabine+cisplatin療法6コース後に肝転移PRとなり,2012年7月胃全摘・D2郭清を施行した。ypT3N1,組織学的効果判定はGrade 1bであった。全例で術後補助療法としてS-1単剤の投与を開始した。症例1は術後6か月で傍大動脈リンパ節再発が出現し,second-line治療としてweekly paclitaxel療法を開始した。6コースでCRとなり,以後継続中である。症例2,3はS-1を8コース終了後は無治療であるが無再発である。術後62～77か月経過し,全例が生存中である。Stage Ⅳ胃癌に対するconversion surgeryが予後の改善につながるか新たな臨床試験が必要と思われる。