内容紹介
Summary
We reported 2 cases of hepatic encephalopathy after chemotherapy for advanced colorectal cancer. Case 1: A 49-year-old male was diagnosed advanced sigmoid colon cancer with peritoneal dissemination, multiple liver metastasis and multiple osseous metastasis. After resection of primary lesion, we administered mFOLFOX6 plus bevacizumab combination therapy. He was in comatose(Japan coma scale 200)3 days after 2 courses of administration of this regimen. Case 2: A 57-year-old female was diagnosed advanced rectal cancer with multiple huge liver metastasis and multiple osseous metastasis. We administered mFOLFOX6 plus panitumumab combination therapy. She was in comatose(Japan coma scale 100)3 days after 10 courses of administration of this regimen. In both cases, radiographic imaging showed no abnormal sign and blood examination revealed a high level of serum ammonia. We diagnosed their disturbance of consciousness as a symptom of hepatic encephalopathy. Branched-chain amino acid infusion rapidly improved disturbance of consciousness. We must consider the symptom, hepatic encephalopathy in patients receiving chemotherapy for advanced colorectal cancer.
要旨
切除不能進行再発大腸癌に対するmFOLFOX6療法施行中に肝性脳症を来した2例を経験した。症例1: 患者は49歳,男性。腹膜播種・多発肝転移・多発脊椎転移を伴うS状結腸癌,T4aN2M1b,Stage Ⅳに対するmFOLFOX6+bevacizumab併用療法2コース3日目に意識障害を生じた。器質的異常を認めず,高アンモニア(NH3)血症(727 μg/dL)を伴う肝性脳症と診断された。症例2: 患者は57歳,女性。多発脊椎転移・多発肝転移,肺転移を伴う直腸癌,T3NxM1b(H3,PUL,OSS),Stage Ⅳに対するmFOLFOX6+panitumumab併用療法10コース3日目に意識障害を生じた。発熱性好中球減少症を伴っていたが,高NH3血症(135 μg/dL)を認め,肝性脳症と診断された。両症例ともに分子鎖アミノ酸の投与で血中NH3濃度と意識状態の改善を認めた。mFOLFOX6療法中は肝性脳症も念頭に置き,予防と治療を行う必要がある。
目次
We reported 2 cases of hepatic encephalopathy after chemotherapy for advanced colorectal cancer. Case 1: A 49-year-old male was diagnosed advanced sigmoid colon cancer with peritoneal dissemination, multiple liver metastasis and multiple osseous metastasis. After resection of primary lesion, we administered mFOLFOX6 plus bevacizumab combination therapy. He was in comatose(Japan coma scale 200)3 days after 2 courses of administration of this regimen. Case 2: A 57-year-old female was diagnosed advanced rectal cancer with multiple huge liver metastasis and multiple osseous metastasis. We administered mFOLFOX6 plus panitumumab combination therapy. She was in comatose(Japan coma scale 100)3 days after 10 courses of administration of this regimen. In both cases, radiographic imaging showed no abnormal sign and blood examination revealed a high level of serum ammonia. We diagnosed their disturbance of consciousness as a symptom of hepatic encephalopathy. Branched-chain amino acid infusion rapidly improved disturbance of consciousness. We must consider the symptom, hepatic encephalopathy in patients receiving chemotherapy for advanced colorectal cancer.
要旨
切除不能進行再発大腸癌に対するmFOLFOX6療法施行中に肝性脳症を来した2例を経験した。症例1: 患者は49歳,男性。腹膜播種・多発肝転移・多発脊椎転移を伴うS状結腸癌,T4aN2M1b,Stage Ⅳに対するmFOLFOX6+bevacizumab併用療法2コース3日目に意識障害を生じた。器質的異常を認めず,高アンモニア(NH3)血症(727 μg/dL)を伴う肝性脳症と診断された。症例2: 患者は57歳,女性。多発脊椎転移・多発肝転移,肺転移を伴う直腸癌,T3NxM1b(H3,PUL,OSS),Stage Ⅳに対するmFOLFOX6+panitumumab併用療法10コース3日目に意識障害を生じた。発熱性好中球減少症を伴っていたが,高NH3血症(135 μg/dL)を認め,肝性脳症と診断された。両症例ともに分子鎖アミノ酸の投与で血中NH3濃度と意識状態の改善を認めた。mFOLFOX6療法中は肝性脳症も念頭に置き,予防と治療を行う必要がある。