内容紹介
Summary
We herein describe a patient on hemodialysis with advanced squamous cell lung cancer who was treated with chemotherapy that consisted of carboplatin(CBDCA)and paclitaxel(PTX). A 54-year-old man who was undergoing a routine hemodialysis for chronic renal failure presented with cold symptoms and was prescribed antibiotics. As no symptomatic improvement was achieved, he was referred to the Department of Internal Medicine in our hospital, where computed tomographic scan findings raised the suspicion of lung cancer. He was then referred to the Department of Surgery. A bronchoscopy detected a tumor, which obstructed the right upper lobe bronchus, and the patient was diagnosed with squamous cell carcinoma. Based on the mediastinal lymph node enlargement that extended into the contralateral hilar region, the stage was determined to be ⅢB(c-T3N3M0), and we initiated chemotherapy. The regimen was CBDCA plus PTX. The carboplatin dose area under the curve(AUC)was 4(100 mg at a glomerular filtration rate of 0)for the first course, AUC 5 for the second course, and AUC 6 for the third to sixth courses, and the PTX dose was 200 mg/m2. Only mild adverse events were noted, and the patient achieved a partial response after 6 treatment courses. Only a few reports have described chemotherapies administered to patients with lung cancer on hemodialysis, and as such, evidence of useful drugs is not yet available. This makes it difficult to select the most appropriate treatment for such patients. We report our experience with this patient, with a relevant literature review.
要旨
今回われわれは,血液透析患者の進行肺扁平上皮癌に対しcarboplatin(CBDCA)+paclitaxel(PTX)による化学療法を行った1例を経験した。症例は54歳,男性。慢性腎不全にて血液透析中,感冒様症状のため抗生剤を処方されたが改善せず,当院内科を紹介されCTで肺癌が疑われたため外科に紹介となった。気管支鏡検査で右上葉枝を閉塞する腫瘍を認め,扁平上皮癌と診断した。縦隔リンパ節は対側肺門まで腫大していたためc-T3N3M0,stage ⅢBと判断し,化学療法の方針とした。治療はCBDCA+PTXを選択し,CBDCAは1コース目をAUC 4(GFR=0として100 mg),2コース目をAUC 5,3～6コース目をAUC 6として,PTXは200 mg/m2として施行した。有害事象は軽度で6コースを行いpartial responseの奏効を得た。透析患者の肺癌に対する化学療法は報告も少なく,使用する薬剤に関するエビデンスはなく治療選択に難渋する。今回の経験も踏まえて若干の文献的考察も加えて報告する。
目次
We herein describe a patient on hemodialysis with advanced squamous cell lung cancer who was treated with chemotherapy that consisted of carboplatin(CBDCA)and paclitaxel(PTX). A 54-year-old man who was undergoing a routine hemodialysis for chronic renal failure presented with cold symptoms and was prescribed antibiotics. As no symptomatic improvement was achieved, he was referred to the Department of Internal Medicine in our hospital, where computed tomographic scan findings raised the suspicion of lung cancer. He was then referred to the Department of Surgery. A bronchoscopy detected a tumor, which obstructed the right upper lobe bronchus, and the patient was diagnosed with squamous cell carcinoma. Based on the mediastinal lymph node enlargement that extended into the contralateral hilar region, the stage was determined to be ⅢB(c-T3N3M0), and we initiated chemotherapy. The regimen was CBDCA plus PTX. The carboplatin dose area under the curve(AUC)was 4(100 mg at a glomerular filtration rate of 0)for the first course, AUC 5 for the second course, and AUC 6 for the third to sixth courses, and the PTX dose was 200 mg/m2. Only mild adverse events were noted, and the patient achieved a partial response after 6 treatment courses. Only a few reports have described chemotherapies administered to patients with lung cancer on hemodialysis, and as such, evidence of useful drugs is not yet available. This makes it difficult to select the most appropriate treatment for such patients. We report our experience with this patient, with a relevant literature review.
要旨
今回われわれは,血液透析患者の進行肺扁平上皮癌に対しcarboplatin(CBDCA)+paclitaxel(PTX)による化学療法を行った1例を経験した。症例は54歳,男性。慢性腎不全にて血液透析中,感冒様症状のため抗生剤を処方されたが改善せず,当院内科を紹介されCTで肺癌が疑われたため外科に紹介となった。気管支鏡検査で右上葉枝を閉塞する腫瘍を認め,扁平上皮癌と診断した。縦隔リンパ節は対側肺門まで腫大していたためc-T3N3M0,stage ⅢBと判断し,化学療法の方針とした。治療はCBDCA+PTXを選択し,CBDCAは1コース目をAUC 4(GFR=0として100 mg),2コース目をAUC 5,3～6コース目をAUC 6として,PTXは200 mg/m2として施行した。有害事象は軽度で6コースを行いpartial responseの奏効を得た。透析患者の肺癌に対する化学療法は報告も少なく,使用する薬剤に関するエビデンスはなく治療選択に難渋する。今回の経験も踏まえて若干の文献的考察も加えて報告する。