内容紹介
Summary
A 55-year-old man underwent distal gastrectomy and D2 lymph node dissection for type 2 gastric cancer of the antrum. One year later, CEA elevation was discovered, and contrast-enhanced abdominal computed tomography(CT)revealed a 40 mm mass in the liver(S8), which was judged to be a metastatic recurrence of the gastric cancer. S-1 plus CDDP was administered in 5 courses, followed by regular treatment with S-1 alone. Two years after the recurrence was diagnosed, the patient's CEA level was found to be normal, and CT revealed almost total scarring. After 2 more years, there was still no sign of recurrence, so, with the patient's consent, we discontinued the chemotherapy. Eight years after the gastrectomy, a 10 mm nodular shadow was observed in the left lower lung lobe, and resection was performed. Despite the earlier diagnosis of gastric adenocarcinoma, this mass was considered a primary lung adenocarcinoma, and the patient died of small-cell lung cancer 11 years and 8 months after the gastrectomy. It is notable that the liver metastasis in this case responded to the S-1 plus CDDP and S-1 therapies, and this response is considered in light of the literature.
要旨
症例は55歳,男性。胃前庭部の2型胃癌に対して開腹幽門側胃切除術,D2リンパ節郭清を施行した。術後1年でCEAの上昇が出現,腹部造影CTにて肝S8に大きさ40 mmの腫瘤を認めた。胃癌術後肝転移再発と診断した。S-1+CDDP療法を5コース施行し縮小傾向にあったため,その後S-1単剤にて治療を継続とした。再発後2年でCEAは正常,CTではほぼ瘢痕化となった。再発後4年までS-1を25コース施行した。S-1を一度中止という方針となり,本人も同意したため経過観察することとした。胃癌術後8年にて左肺下葉に10 mm大の結節影を認め,切除を行うも原発性肺腺癌と診断された。胃癌術後11年8か月で肺小細胞癌にて死亡した。今回,胃癌術後肝転移再発に対してS-1+CDDPおよびS-1療法が奏効した1例を経験したので,文献的考察を加え報告する。
目次
A 55-year-old man underwent distal gastrectomy and D2 lymph node dissection for type 2 gastric cancer of the antrum. One year later, CEA elevation was discovered, and contrast-enhanced abdominal computed tomography(CT)revealed a 40 mm mass in the liver(S8), which was judged to be a metastatic recurrence of the gastric cancer. S-1 plus CDDP was administered in 5 courses, followed by regular treatment with S-1 alone. Two years after the recurrence was diagnosed, the patient's CEA level was found to be normal, and CT revealed almost total scarring. After 2 more years, there was still no sign of recurrence, so, with the patient's consent, we discontinued the chemotherapy. Eight years after the gastrectomy, a 10 mm nodular shadow was observed in the left lower lung lobe, and resection was performed. Despite the earlier diagnosis of gastric adenocarcinoma, this mass was considered a primary lung adenocarcinoma, and the patient died of small-cell lung cancer 11 years and 8 months after the gastrectomy. It is notable that the liver metastasis in this case responded to the S-1 plus CDDP and S-1 therapies, and this response is considered in light of the literature.
要旨
症例は55歳,男性。胃前庭部の2型胃癌に対して開腹幽門側胃切除術,D2リンパ節郭清を施行した。術後1年でCEAの上昇が出現,腹部造影CTにて肝S8に大きさ40 mmの腫瘤を認めた。胃癌術後肝転移再発と診断した。S-1+CDDP療法を5コース施行し縮小傾向にあったため,その後S-1単剤にて治療を継続とした。再発後2年でCEAは正常,CTではほぼ瘢痕化となった。再発後4年までS-1を25コース施行した。S-1を一度中止という方針となり,本人も同意したため経過観察することとした。胃癌術後8年にて左肺下葉に10 mm大の結節影を認め,切除を行うも原発性肺腺癌と診断された。胃癌術後11年8か月で肺小細胞癌にて死亡した。今回,胃癌術後肝転移再発に対してS-1+CDDPおよびS-1療法が奏効した1例を経験したので,文献的考察を加え報告する。