内容紹介
Summary
56-year-old man with advanced RCC and a past medical history of type 2 diabetes underwent a radical left nephrectomy following a histological diagnosis of papillary RCC, G2, INF β, pT3, V1 in 1999. In 2008, sorafenib was started to treat multiple pulmonary metastases of RCC. In 2011, sorafenib was switched to sunitinib when radiologic progression was observed. In 2014, sunitinib was switched to axitinib when further radiologic progression was observed. In 2015, the patient was referred to Yazawa clinic for homecare urology when hospital visits became difficult due to cancer pain and bilateral lower-extremity muscle weakness. Cancer pain was controlled using acetaminophen and a fentanyl patch. During the administration of axitinib, a CTCAE grade 1 vocal disorder was detected. We reduced the axitinib dose from 10 mg to 6 mg, and valsartan and an antiflatulent were administered due to CTCAE grade 2 hypertension and diarrhea, respectively. Axitinib administration continued until the patient died. He had survived more than 11 years following the detection of lung metastasis. In this patient, a good balance between cancer treatment and palliative care was achieved through the application of homecare urology. In a super-aged society such as Japan, urologists with an awareness of Zaitaku Medicine, a Japanese style of homecare that provides continuing appropriate medical treatment and welfare support to patients with access barriers to hospital treatment to enable them to live out the remainder of their lives with dignity, may play a key role in the development of Zaitaku Medicine.
要旨
症例は56歳,男性。1999年,左腎がんに対して根治的左腎摘除術を施行し,papillary RCC,G2,INFβ,pT3,V1であった。2008年より多発肺転移に対してソラフェニブを開始した。2011年にprogressive disease(PD)となりスニチニブに変更,2014年にPDとなりアキシチニブ10 mg/日に変更した。2015年よりがん疼痛と下肢筋力低下に伴い通院が困難となり,在宅医療を導入した。がん疼痛に対してはアセトアミノフェン4,000 mg/日とフェンタニルテープ1 mgでコントロール良好であった。アキシチニブ投与中の有害事象としては,CTCAE grade 2の高血圧を認め,バルサルタン80 mgを開始した。またgrade 2の下痢を認め,アキシチニブ6 mg/日への減量と整腸剤を投与し改善傾向を認め,アキシチニブを最期まで継続し得た。本症例において泌尿器科在宅医療の導入により,血管新生阻害薬の継続と緩和ケアとの両立が可能であった。超高齢社会における在宅医療に親和性の高い泌尿器科医が在宅医療の現場にでていくことで,新たな課題設定ならびに課題解決に取り組める可能性があると考えられた。
目次
56-year-old man with advanced RCC and a past medical history of type 2 diabetes underwent a radical left nephrectomy following a histological diagnosis of papillary RCC, G2, INF β, pT3, V1 in 1999. In 2008, sorafenib was started to treat multiple pulmonary metastases of RCC. In 2011, sorafenib was switched to sunitinib when radiologic progression was observed. In 2014, sunitinib was switched to axitinib when further radiologic progression was observed. In 2015, the patient was referred to Yazawa clinic for homecare urology when hospital visits became difficult due to cancer pain and bilateral lower-extremity muscle weakness. Cancer pain was controlled using acetaminophen and a fentanyl patch. During the administration of axitinib, a CTCAE grade 1 vocal disorder was detected. We reduced the axitinib dose from 10 mg to 6 mg, and valsartan and an antiflatulent were administered due to CTCAE grade 2 hypertension and diarrhea, respectively. Axitinib administration continued until the patient died. He had survived more than 11 years following the detection of lung metastasis. In this patient, a good balance between cancer treatment and palliative care was achieved through the application of homecare urology. In a super-aged society such as Japan, urologists with an awareness of Zaitaku Medicine, a Japanese style of homecare that provides continuing appropriate medical treatment and welfare support to patients with access barriers to hospital treatment to enable them to live out the remainder of their lives with dignity, may play a key role in the development of Zaitaku Medicine.
要旨
症例は56歳,男性。1999年,左腎がんに対して根治的左腎摘除術を施行し,papillary RCC,G2,INFβ,pT3,V1であった。2008年より多発肺転移に対してソラフェニブを開始した。2011年にprogressive disease(PD)となりスニチニブに変更,2014年にPDとなりアキシチニブ10 mg/日に変更した。2015年よりがん疼痛と下肢筋力低下に伴い通院が困難となり,在宅医療を導入した。がん疼痛に対してはアセトアミノフェン4,000 mg/日とフェンタニルテープ1 mgでコントロール良好であった。アキシチニブ投与中の有害事象としては,CTCAE grade 2の高血圧を認め,バルサルタン80 mgを開始した。またgrade 2の下痢を認め,アキシチニブ6 mg/日への減量と整腸剤を投与し改善傾向を認め,アキシチニブを最期まで継続し得た。本症例において泌尿器科在宅医療の導入により,血管新生阻害薬の継続と緩和ケアとの両立が可能であった。超高齢社会における在宅医療に親和性の高い泌尿器科医が在宅医療の現場にでていくことで,新たな課題設定ならびに課題解決に取り組める可能性があると考えられた。