内容紹介
Summary
We present a case of a 74-year-old man who was a heavy smoker with a performance status of 0(Brinkman index of 2080). In 2008, he was diagnosed with idiopathic pulmonary fibrosis and was treated with pirfenidone. During follow-up, abnormal chest shadows were observed. In May 2014, he was diagnosed with right middle lobe primary squamous cell carcinoma of the lung(C-T2aN2M1a, contralateral lung metastasis)Ⅳa, for which chemotherapy was immediately initiated. After 3 courses of carboplatin(5 AUC, day 1)plus nanoparticle albumin-bound paclitaxel(100 mg/m2, days 1, 8, and 15)treatment, the primary tumor markedly decreased in size(reduction ratio, 93.3%). Moreover, both the mediastinal lymph nodes and lung metastatic lesions disappeared, and the level of tumor marker CYFRA had decreased from 29.5 to 3.4 ng/mL. The patient then underwent thoracoscopic partial resection of the right middle lobe of the lung, as a combination of these chemotherapeutic agents with salvage surgery is the standard treatment regimen for residual middle lobe lung tumors. Subsequently, he was discharged from the hospital without complications. Three courses of the same chemotherapeutic agents were administered post-surgery. As of August 2017, the patient was alive without any recurrence during the outpatient follow-up.
要旨
症例は74歳,男性。PS 0,重喫煙者(Brinkman index 2080)。2008年から特発性肺線維症の診断でpirfenidoneを投薬中に胸部異常陰影を指摘された。2014年5月右中葉原発扁平上皮癌C-T2aN2M1a(対側肺転移)-Ⅳaと診断,化学療法を施行した。carboplatin(5 AUC,day 1)+nab-paclitaxel(100 mg/m2,days 1,8,15)を3コース施行後,原発巣は縮小し(縮小率93.3%),縦隔リンパ節と対側肺転移巣は消失,腫瘍マーカーは低下した(CYFRA 29.5→3.4 ng/mL)。残存中葉腫瘍に対するサルベージ手術の方針となり,胸腔鏡下右中葉部分切除を施行し軽快退院となった。術後に同様の化学療法を3コース施行し,2017年8月現在,無再発で外来通院中である。
目次
We present a case of a 74-year-old man who was a heavy smoker with a performance status of 0(Brinkman index of 2080). In 2008, he was diagnosed with idiopathic pulmonary fibrosis and was treated with pirfenidone. During follow-up, abnormal chest shadows were observed. In May 2014, he was diagnosed with right middle lobe primary squamous cell carcinoma of the lung(C-T2aN2M1a, contralateral lung metastasis)Ⅳa, for which chemotherapy was immediately initiated. After 3 courses of carboplatin(5 AUC, day 1)plus nanoparticle albumin-bound paclitaxel(100 mg/m2, days 1, 8, and 15)treatment, the primary tumor markedly decreased in size(reduction ratio, 93.3%). Moreover, both the mediastinal lymph nodes and lung metastatic lesions disappeared, and the level of tumor marker CYFRA had decreased from 29.5 to 3.4 ng/mL. The patient then underwent thoracoscopic partial resection of the right middle lobe of the lung, as a combination of these chemotherapeutic agents with salvage surgery is the standard treatment regimen for residual middle lobe lung tumors. Subsequently, he was discharged from the hospital without complications. Three courses of the same chemotherapeutic agents were administered post-surgery. As of August 2017, the patient was alive without any recurrence during the outpatient follow-up.
要旨
症例は74歳,男性。PS 0,重喫煙者(Brinkman index 2080)。2008年から特発性肺線維症の診断でpirfenidoneを投薬中に胸部異常陰影を指摘された。2014年5月右中葉原発扁平上皮癌C-T2aN2M1a(対側肺転移)-Ⅳaと診断,化学療法を施行した。carboplatin(5 AUC,day 1)+nab-paclitaxel(100 mg/m2,days 1,8,15)を3コース施行後,原発巣は縮小し(縮小率93.3%),縦隔リンパ節と対側肺転移巣は消失,腫瘍マーカーは低下した(CYFRA 29.5→3.4 ng/mL)。残存中葉腫瘍に対するサルベージ手術の方針となり,胸腔鏡下右中葉部分切除を施行し軽快退院となった。術後に同様の化学療法を3コース施行し,2017年8月現在,無再発で外来通院中である。