内容紹介
Summary
Although chemotherapy is the standard treatment for unresectable advanced gastric cancer, its prognosis is poor and the median survival time is only around 10 months. With some literature consideration, we report that ovarian metastasis triggered the diagnosis of unresectable advanced gastric cancer with long-term survival through multidisciplinary treatment. This is the case of a 69-year-old woman, who was diagnosed with ovarian tumor and underwent right extracorporectomy and omentum resection in 2011. Pathological diagnosis suspected adenocarcinoma. In February 2012, EGD found a type 4 tumor in the upper portion of the pyloric area of the stomach. She was diagnosed with gastric cancer with Stage Ⅳ(T4aN0M1[ovary])ovarian metastasis. Because the primary tumor was HER2 positive, XP plus HER therapy(capecitabine 1,000 mg/m2 twice a day for 14 days, CDDP 80 mg/m2 every 3 weeks on the first day, and trastuzumab 8 mg/kg every 3 weeks on the first day)was administered since March 2012. No metastasis was found in the imaging examination after 8 courses of chemotherapy, and we also confirmed the reduction of the primary tumor in the EGD. Based on the images, primary resection was already possible. In December 2012, after a diagnostic laparoscopy, total gastrectomy with D2 lymph node dissection was performed. Postoperative pathology was diagnosed as Stage Ⅳ(pT4aN0M1). To control postoperative micrometastasis, capecitabine therapy(1,000 mg/m2 twice a day for 14 days)was administered for 12 months starting from February 2013. Then, recurrence and metastasis were not observed during follow-up. However, in January 2017, a circumstellar stenotic tumor was found in the rectum and was diagnosed as recurrence of peritoneal dissemination through images. In February 2017, artificial ostomy(in the sigmoid colon, double-mouth type)was made. Then, the patient underwent an outpatient chemotherapy, with hospital visits, and she survives.
要旨
切除不能進行胃癌に対する標準治療は全身化学療法であるが,生存期間の中央値は10か月程度で予後は不良である。今回,卵巣転移を契機に切除不能進行胃癌と診断し集学的治療を施行し長期生存が得られた1例を経験したので,若干の文献的考察を加えて報告する。症例は69歳,女性。2011年に卵巣腫瘍を指摘され,右付属器摘出術と大網切除術を施行した。病理結果は低分化腺癌および印環細胞癌で転移性が強く疑われた。2012年2月に上部消化管内視鏡で胃体上部から幽門部にかけて4型の腫瘍を認めた。胃癌卵巣転移Stage Ⅳ[T4aN0M1(ovary)]の診断となった。原発巣のHER2が陽性であったため,2012年3月からXP+HER(capecitabine 1,000 mg/m2 1日2回14日間,CDDP 80 mg/m2 1日目に3週毎,trastuzumab 8 mg/kg 1日目に3週毎)を施行した。化学療法8コース施行後の画像検査で遠隔転移所見はなく,また上部消化管内視鏡検査も原発巣の縮小を認めた。画像所見から原発巣切除は可能と判断し,2012年12月に診断的腹腔鏡施行後に開腹胃全摘およびD2リンパ節郭清術を施行した。術後病理はStage Ⅳ(pT4aN0M1)の診断となった。術後2013年2月から微小転移の制御目的にcapecitabine(1,000 mg/m2 1日2回14日間)療法を12か月施行し,以後外来経過観察となった。その後,再発や転移所見を認めずに経過したが,2017年1月に直腸に全周性の狭窄病変を認め,画像上腹膜播種再発の診断となった。2017年2月に人工肛門造設術(S状結腸,双口式)を施行し,現在外来化学療法を施行し通院生存中である。
目次
Although chemotherapy is the standard treatment for unresectable advanced gastric cancer, its prognosis is poor and the median survival time is only around 10 months. With some literature consideration, we report that ovarian metastasis triggered the diagnosis of unresectable advanced gastric cancer with long-term survival through multidisciplinary treatment. This is the case of a 69-year-old woman, who was diagnosed with ovarian tumor and underwent right extracorporectomy and omentum resection in 2011. Pathological diagnosis suspected adenocarcinoma. In February 2012, EGD found a type 4 tumor in the upper portion of the pyloric area of the stomach. She was diagnosed with gastric cancer with Stage Ⅳ(T4aN0M1[ovary])ovarian metastasis. Because the primary tumor was HER2 positive, XP plus HER therapy(capecitabine 1,000 mg/m2 twice a day for 14 days, CDDP 80 mg/m2 every 3 weeks on the first day, and trastuzumab 8 mg/kg every 3 weeks on the first day)was administered since March 2012. No metastasis was found in the imaging examination after 8 courses of chemotherapy, and we also confirmed the reduction of the primary tumor in the EGD. Based on the images, primary resection was already possible. In December 2012, after a diagnostic laparoscopy, total gastrectomy with D2 lymph node dissection was performed. Postoperative pathology was diagnosed as Stage Ⅳ(pT4aN0M1). To control postoperative micrometastasis, capecitabine therapy(1,000 mg/m2 twice a day for 14 days)was administered for 12 months starting from February 2013. Then, recurrence and metastasis were not observed during follow-up. However, in January 2017, a circumstellar stenotic tumor was found in the rectum and was diagnosed as recurrence of peritoneal dissemination through images. In February 2017, artificial ostomy(in the sigmoid colon, double-mouth type)was made. Then, the patient underwent an outpatient chemotherapy, with hospital visits, and she survives.
要旨
切除不能進行胃癌に対する標準治療は全身化学療法であるが,生存期間の中央値は10か月程度で予後は不良である。今回,卵巣転移を契機に切除不能進行胃癌と診断し集学的治療を施行し長期生存が得られた1例を経験したので,若干の文献的考察を加えて報告する。症例は69歳,女性。2011年に卵巣腫瘍を指摘され,右付属器摘出術と大網切除術を施行した。病理結果は低分化腺癌および印環細胞癌で転移性が強く疑われた。2012年2月に上部消化管内視鏡で胃体上部から幽門部にかけて4型の腫瘍を認めた。胃癌卵巣転移Stage Ⅳ[T4aN0M1(ovary)]の診断となった。原発巣のHER2が陽性であったため,2012年3月からXP+HER(capecitabine 1,000 mg/m2 1日2回14日間,CDDP 80 mg/m2 1日目に3週毎,trastuzumab 8 mg/kg 1日目に3週毎)を施行した。化学療法8コース施行後の画像検査で遠隔転移所見はなく,また上部消化管内視鏡検査も原発巣の縮小を認めた。画像所見から原発巣切除は可能と判断し,2012年12月に診断的腹腔鏡施行後に開腹胃全摘およびD2リンパ節郭清術を施行した。術後病理はStage Ⅳ(pT4aN0M1)の診断となった。術後2013年2月から微小転移の制御目的にcapecitabine(1,000 mg/m2 1日2回14日間)療法を12か月施行し,以後外来経過観察となった。その後,再発や転移所見を認めずに経過したが,2017年1月に直腸に全周性の狭窄病変を認め,画像上腹膜播種再発の診断となった。2017年2月に人工肛門造設術(S状結腸,双口式)を施行し,現在外来化学療法を施行し通院生存中である。