内容紹介
Summary
A 77-year-old man was diagnosed with ascending colon cancer with synchronous liver metastasis. Per our policy we first only performed a right hemicolectomy(pSSN2H2M0, stage Ⅳ). We then planned S-1 and oxaliplatin(SOX)plus bevacizumab(Bmab)chemotherapy as a neoadjuvant for the resection of liver metastasis. After 4 courses, enhanced CT and EOB-MRI findings showed the liver tumor had significantly decreased in size with no side effects, and we performed a partial liver resection for the S7 lesion. Postoperatively, histopathological analysis revealed only a fibrotic lesion and no cancerous cells in the resected specimen, indicating that chemotherapy had downgraded the tumor to Grade 3. Adjuvant chemotherapy was not continued owing to the patient's refusal, but no recurrence was noted 18 months after the second operation. SOX plus Bmab chemotherapy is, therefore, effective in terms of its anti-tumor effects, tolerance, and accessibility. We believe SOX plus Bmab chemotherapy can be considered as an effective option for cases with synchronous liver metastasis of colon cancer as neoadjuvant chemotherapy for interval liver resection.
要旨
症例は77歳,男性。下血を主訴に発見された全周性の上行結腸癌で,術前検査にて肝S7に約51 mmの腫瘤を認め,同時性肝転移を伴う局所進行癌と診断した。先行して結腸右半切除術+D3郭清を施行した(pSSN2H2M0,stage Ⅳ)。その後,術前化学療法としてS-1,oxaliplatin(SOX)+bevacizumab(Bmab)療法を4コース施行し,有害事象の発現は認めなかった。腹部造影CT検査および腹部EOB-MRI造影検査にて肝転移巣の著明な縮小を認めたため,肝S7部分切除術を施行した。病理組織学的検査所見では,切除標本内には線維化組織を認めるのみで,viableな腫瘍細胞は認めず組織学的効果判定はGrade 3であった。患者本人の希望により術後補助化学療法は未施行であるが,術後1年6か月経過した現在も無再発生存中である。SOX+Bmab療法は,抗腫瘍効果に加え忍容性,利便性という点においても優れており,本症例のような大腸癌同時性肝転移症例において,二期的切除における肝切除前の術前化学療法として有用な選択肢の一つになり得ると考えられた。
目次
A 77-year-old man was diagnosed with ascending colon cancer with synchronous liver metastasis. Per our policy we first only performed a right hemicolectomy(pSSN2H2M0, stage Ⅳ). We then planned S-1 and oxaliplatin(SOX)plus bevacizumab(Bmab)chemotherapy as a neoadjuvant for the resection of liver metastasis. After 4 courses, enhanced CT and EOB-MRI findings showed the liver tumor had significantly decreased in size with no side effects, and we performed a partial liver resection for the S7 lesion. Postoperatively, histopathological analysis revealed only a fibrotic lesion and no cancerous cells in the resected specimen, indicating that chemotherapy had downgraded the tumor to Grade 3. Adjuvant chemotherapy was not continued owing to the patient's refusal, but no recurrence was noted 18 months after the second operation. SOX plus Bmab chemotherapy is, therefore, effective in terms of its anti-tumor effects, tolerance, and accessibility. We believe SOX plus Bmab chemotherapy can be considered as an effective option for cases with synchronous liver metastasis of colon cancer as neoadjuvant chemotherapy for interval liver resection.
要旨
症例は77歳,男性。下血を主訴に発見された全周性の上行結腸癌で,術前検査にて肝S7に約51 mmの腫瘤を認め,同時性肝転移を伴う局所進行癌と診断した。先行して結腸右半切除術+D3郭清を施行した(pSSN2H2M0,stage Ⅳ)。その後,術前化学療法としてS-1,oxaliplatin(SOX)+bevacizumab(Bmab)療法を4コース施行し,有害事象の発現は認めなかった。腹部造影CT検査および腹部EOB-MRI造影検査にて肝転移巣の著明な縮小を認めたため,肝S7部分切除術を施行した。病理組織学的検査所見では,切除標本内には線維化組織を認めるのみで,viableな腫瘍細胞は認めず組織学的効果判定はGrade 3であった。患者本人の希望により術後補助化学療法は未施行であるが,術後1年6か月経過した現在も無再発生存中である。SOX+Bmab療法は,抗腫瘍効果に加え忍容性,利便性という点においても優れており,本症例のような大腸癌同時性肝転移症例において,二期的切除における肝切除前の術前化学療法として有用な選択肢の一つになり得ると考えられた。