内容紹介
Summary
A 61-year-old woman was introduced for consultation with a chief complaint of frequent vomiting. CT revealed a pancreatic body cancer approximately 40 mm in size; an invading stenosis from the horizontal part of the duodenum to the jejunum, superior mesenteric artery, and portal vein, splenic vein obstruction, lymphadenopathy, and some ascitic fluid. We diagnosed a passage disorder due to the invasive stenosis from the horizontal part of the duodenum of the pancreatic body cancer to the jejunum, and subsequently performed a duodenum and jejunum bypass operation. We controlled cancer pain with opioid analgesia, and S-1 monotherapy was chosen as the primary chemotherapy. A tendency to increase and the cancer pain of the tumor was aggravated when 5 courses took effect, so gemcitabine plus nab-paclitaxel(GEM plus nab-PTX)therapy was chosen as the second-line chemotherapy because of adverse Grade 3 events due to difficulties with S-1 internal use. We tapered off the opioid analgesia dosage because the cancer pain was relieved after 1 course. The imaging top indicated stable disease at the end of 5 courses, but the pain was relieved so opioid pain killers were unnecessary. Foreign continuation is under treatment with 10-course GEM plus nab-PTX therapy after initial diagnosis. Currently, the patient has undergone 5 courses of S-1 for approximately 18 months, and has achieved stable disease. The only adverse events were nausea, fatigue, Grade 1 malaise, and Grade 2 alopecia, as detected with imaging.
要旨
症例は61歳,女性。頻回の嘔吐を主訴に紹介受診となった。腹部CTにて大きさ約40 mmの膵体部癌が存在し,十二指腸水平部から空腸にかけての浸潤狭窄,上腸間膜動脈浸潤,門脈・脾静脈閉塞,リンパ節腫大,少量の腹水を認めた(stageⅣb)。膵体部癌の十二指腸水平部から空腸にかけての浸潤狭窄による通過障害と診断し,十二指腸・空腸バイパス術を施行した。癌性疼痛に対してはオピオイド鎮痛薬にてコントロールし,一次化学療法はS-1療法を選択された。5コース施行した時点で腫瘍の増大傾向と癌性疼痛が増悪し,Grade 3の有害事象により続行困難となったため,二次化学療法としてgemcitabine+nab-paclitaxel(GEM+nab-PTX)併用療法を選択した。1コース終了後より癌性疼痛が軽減したためオピオイド鎮痛薬を漸減した。5コース終了時には画像診断上はstable diseaseだが,オピオイド鎮痛剤を必要としないほど疼痛が軽減した。初診時から約18か月,S-1を5コース,現在10コース目のGEM+nab-PTX併用療法を外来継続治療中である。
目次
A 61-year-old woman was introduced for consultation with a chief complaint of frequent vomiting. CT revealed a pancreatic body cancer approximately 40 mm in size; an invading stenosis from the horizontal part of the duodenum to the jejunum, superior mesenteric artery, and portal vein, splenic vein obstruction, lymphadenopathy, and some ascitic fluid. We diagnosed a passage disorder due to the invasive stenosis from the horizontal part of the duodenum of the pancreatic body cancer to the jejunum, and subsequently performed a duodenum and jejunum bypass operation. We controlled cancer pain with opioid analgesia, and S-1 monotherapy was chosen as the primary chemotherapy. A tendency to increase and the cancer pain of the tumor was aggravated when 5 courses took effect, so gemcitabine plus nab-paclitaxel(GEM plus nab-PTX)therapy was chosen as the second-line chemotherapy because of adverse Grade 3 events due to difficulties with S-1 internal use. We tapered off the opioid analgesia dosage because the cancer pain was relieved after 1 course. The imaging top indicated stable disease at the end of 5 courses, but the pain was relieved so opioid pain killers were unnecessary. Foreign continuation is under treatment with 10-course GEM plus nab-PTX therapy after initial diagnosis. Currently, the patient has undergone 5 courses of S-1 for approximately 18 months, and has achieved stable disease. The only adverse events were nausea, fatigue, Grade 1 malaise, and Grade 2 alopecia, as detected with imaging.
要旨
症例は61歳,女性。頻回の嘔吐を主訴に紹介受診となった。腹部CTにて大きさ約40 mmの膵体部癌が存在し,十二指腸水平部から空腸にかけての浸潤狭窄,上腸間膜動脈浸潤,門脈・脾静脈閉塞,リンパ節腫大,少量の腹水を認めた(stageⅣb)。膵体部癌の十二指腸水平部から空腸にかけての浸潤狭窄による通過障害と診断し,十二指腸・空腸バイパス術を施行した。癌性疼痛に対してはオピオイド鎮痛薬にてコントロールし,一次化学療法はS-1療法を選択された。5コース施行した時点で腫瘍の増大傾向と癌性疼痛が増悪し,Grade 3の有害事象により続行困難となったため,二次化学療法としてgemcitabine+nab-paclitaxel(GEM+nab-PTX)併用療法を選択した。1コース終了後より癌性疼痛が軽減したためオピオイド鎮痛薬を漸減した。5コース終了時には画像診断上はstable diseaseだが,オピオイド鎮痛剤を必要としないほど疼痛が軽減した。初診時から約18か月,S-1を5コース,現在10コース目のGEM+nab-PTX併用療法を外来継続治療中である。