内容紹介
Summary
We report a case of resected esophageal cancer that responded well to first-line combination therapy comprising irinotecan and cisplatin. The patient was a 71-year-old woman being treated for liver cirrhosis. She was admitted to our hospital in April 2015 because of dysphasia. Endoscopic examination revealed a tumor in the mid-thoracic esophagus, which was diagnosed as an endocrine cell carcinoma following pathological examination. Contrast-enhanced computed tomography and positron emission tomography did not show lymph node or distant metastases. She was treated with irinotecan and cisplatin combination therapy. After 6 courses of treatment, the tumor size had remarkably reduced. Subsequently, we performed subtotal esophagectomy and gastric tube reconstruction through the retroposterior mediastinal route and the histological effect was reported as a partial response. No viable tumor cells were observed in the extracted lymph nodes. However, bone metastasis and lymph node swelling occurred after 4 months. She received other therapeutic regimens, such as etoposide and carboplatin combination therapy. However, the tumor gradually progressed, and she died 18 months after the first treatment. Irinotecan and cisplatin combination therapy is a possible option for the management of esophageal endocrine cell carcinoma as a first-line treatment.
要旨
症例は71歳,女性。2015年1月はじめより嚥下困難を自覚していた。4月に上部消化管内視鏡検査を施行したところ胸部中部食道に隆起性病変を認め,生検でシナプトフィジンおよびCD56陽性のため食道内分泌細胞癌と診断した。CTで転移を認めず,PET-CTで原発巣の他はFDGの異常集積はなかった。5月よりirinotecan+cisplatin(IP)療法を開始した。6コース後の内視鏡検査では,腫瘍は著明に縮小していた。CTで明らかな転移は認められなかったため,11月食道亜全摘術を行った。切除標本で腫瘍は残存していたが,リンパ節転移はなかった。2016年3月のCTで左坐骨転移を認めたため,4月よりetoposide+carboplatin療法を開始した。しかし,食欲不振のため2コースで中止となり,10月に死亡した。食道内分泌細胞癌のfirst-lineとしてIP療法は有効である。再発した場合のレジメンは確立しておらず,今後検討すべき課題である。
目次
We report a case of resected esophageal cancer that responded well to first-line combination therapy comprising irinotecan and cisplatin. The patient was a 71-year-old woman being treated for liver cirrhosis. She was admitted to our hospital in April 2015 because of dysphasia. Endoscopic examination revealed a tumor in the mid-thoracic esophagus, which was diagnosed as an endocrine cell carcinoma following pathological examination. Contrast-enhanced computed tomography and positron emission tomography did not show lymph node or distant metastases. She was treated with irinotecan and cisplatin combination therapy. After 6 courses of treatment, the tumor size had remarkably reduced. Subsequently, we performed subtotal esophagectomy and gastric tube reconstruction through the retroposterior mediastinal route and the histological effect was reported as a partial response. No viable tumor cells were observed in the extracted lymph nodes. However, bone metastasis and lymph node swelling occurred after 4 months. She received other therapeutic regimens, such as etoposide and carboplatin combination therapy. However, the tumor gradually progressed, and she died 18 months after the first treatment. Irinotecan and cisplatin combination therapy is a possible option for the management of esophageal endocrine cell carcinoma as a first-line treatment.
要旨
症例は71歳,女性。2015年1月はじめより嚥下困難を自覚していた。4月に上部消化管内視鏡検査を施行したところ胸部中部食道に隆起性病変を認め,生検でシナプトフィジンおよびCD56陽性のため食道内分泌細胞癌と診断した。CTで転移を認めず,PET-CTで原発巣の他はFDGの異常集積はなかった。5月よりirinotecan+cisplatin(IP)療法を開始した。6コース後の内視鏡検査では,腫瘍は著明に縮小していた。CTで明らかな転移は認められなかったため,11月食道亜全摘術を行った。切除標本で腫瘍は残存していたが,リンパ節転移はなかった。2016年3月のCTで左坐骨転移を認めたため,4月よりetoposide+carboplatin療法を開始した。しかし,食欲不振のため2コースで中止となり,10月に死亡した。食道内分泌細胞癌のfirst-lineとしてIP療法は有効である。再発した場合のレジメンは確立しておらず,今後検討すべき課題である。