内容紹介
Summary
An 84-years-old man underwent total gastrectomy with D1 plus lymph node dissection in December 2015, and diagnosed as Stage ⅢB neuroendocrine carcinoma of the stomach. An abdominal computed tomography revealed swollen paraaortic lymph nodes and left adrenal grand in May 2016. Since his serum level of CA19-9 was elevated, he was thus diagnosed as having recurrence, and was started chemotherapy with ramucirumab(RAM). After introduction of the chemotherapy, his serum level of CA19-9 was decreased gradually and metastatic foci were also decreased in size. Although the patient required relatively longer administration interval according to the severity of general fatigue, he continued the chemotherapy without severe adverse effects until he rejected further treatment in January 2017, and satisfactory therapeutic result was acquired. While the prognosis of gastric neuroendocrine carcinoma is reported to be very poor, no definitive therapeutic guideline is available at present. Especially in elderly patients, we should pay considerable attention to the selection of chemotherapeutic agents because of their own adverse effects. In the present case, RAM could be administered safely, and it seemed that RAM might become a useful therapeutic option for gastric neuroendocrine carcinoma even in elderly patients.
要旨
症例は84歳,男性。Stage ⅢBの胃神経内分泌細胞癌に対して2015年12月に胃全摘術,D1+郭清,Roux-en-Y再建を施行した。2016年5月,腹部CT検査において大動脈周囲リンパ節および左副腎の腫大を指摘され,CA19-9の上昇も認めたことから再発と診断された。6月よりramucirumab(RAM)単剤療法を開始した。CA19-9は徐々に低下し,大動脈周囲リンパ節および左副腎は縮小傾向でPRが得られた。全身倦怠感のため治療休止期間を要したが,2017年1月に全身倦怠感の増強を理由に投与を中止するまでの間,総じて大きな有害事象なく経過し,良好な治療効果が得られた。胃神経内分泌細胞癌の予後は極めて不良であるが,有用な化学療法について一定の指針はない。特に高齢者では有害事象が懸念されるため,治療薬の選択には慎重な判断が求められる。本例ではRAMは安全に投与可能であり,RAMは胃神経内分泌細胞癌に対して有用な治療法の一つである可能性が示唆された。
目次
An 84-years-old man underwent total gastrectomy with D1 plus lymph node dissection in December 2015, and diagnosed as Stage ⅢB neuroendocrine carcinoma of the stomach. An abdominal computed tomography revealed swollen paraaortic lymph nodes and left adrenal grand in May 2016. Since his serum level of CA19-9 was elevated, he was thus diagnosed as having recurrence, and was started chemotherapy with ramucirumab(RAM). After introduction of the chemotherapy, his serum level of CA19-9 was decreased gradually and metastatic foci were also decreased in size. Although the patient required relatively longer administration interval according to the severity of general fatigue, he continued the chemotherapy without severe adverse effects until he rejected further treatment in January 2017, and satisfactory therapeutic result was acquired. While the prognosis of gastric neuroendocrine carcinoma is reported to be very poor, no definitive therapeutic guideline is available at present. Especially in elderly patients, we should pay considerable attention to the selection of chemotherapeutic agents because of their own adverse effects. In the present case, RAM could be administered safely, and it seemed that RAM might become a useful therapeutic option for gastric neuroendocrine carcinoma even in elderly patients.
要旨
症例は84歳,男性。Stage ⅢBの胃神経内分泌細胞癌に対して2015年12月に胃全摘術,D1+郭清,Roux-en-Y再建を施行した。2016年5月,腹部CT検査において大動脈周囲リンパ節および左副腎の腫大を指摘され,CA19-9の上昇も認めたことから再発と診断された。6月よりramucirumab(RAM)単剤療法を開始した。CA19-9は徐々に低下し,大動脈周囲リンパ節および左副腎は縮小傾向でPRが得られた。全身倦怠感のため治療休止期間を要したが,2017年1月に全身倦怠感の増強を理由に投与を中止するまでの間,総じて大きな有害事象なく経過し,良好な治療効果が得られた。胃神経内分泌細胞癌の予後は極めて不良であるが,有用な化学療法について一定の指針はない。特に高齢者では有害事象が懸念されるため,治療薬の選択には慎重な判断が求められる。本例ではRAMは安全に投与可能であり,RAMは胃神経内分泌細胞癌に対して有用な治療法の一つである可能性が示唆された。