内容紹介
Summary
We herein report a Stage Ⅳ case of rectal cancer in a patient who achieved stable disease and was treated monthly with fluorouracil(FU)monotherapy plus bevacizumab(Bmab)against relapse after residual tumor resection and withdrawal because of refusal to continue chemotherapy, even though a marked response was obtained with standard chemotherapy. A 73-year-old woman visited a former hospital in 2014, and was diagnosed with rectal cancer with liver and lung metastases(diagnosed with Rb, T3, M1b[liver, lung]cStage Ⅳ). Chemotherapy(mFOLFOX6 plus Bmab)was initiated with a consideration of conversion. After 5 courses, she moved to our hospital. Since she was not aggressive to chemotherapy from the beginning, an imaging examination was performed after 9 courses. The primary lesion and lung metastases had disappeared, and there was only one liver metastasis. Partial hepatic resection was performed to attempt chemotherapy withdrawal following informed consent. Six months after surgery with no therapy, since relapse in the rectum and lungs was confirmed, laparoscopic rectal amputation was performed to control the primary tumor. Chemotherapy containing FU monotherapy plus Bmab was reinitiated after 15 months of withdrawal because liver and lung metastases increased 5 months after rectal amputation. Two months after resuming chemotherapy, the metastatic lesion decreased in size, and the tumor marker level normalized. The same regimen is continued monthly, and the response has been maintained for 17 months(infusions of 5-FU/LV plus Bmab, 18 courses).
要旨
今回われわれは,標準治療が奏効するも治療を半ば拒否する症例に対し残存腫瘍切除と休薬を行い,再燃後にFU単剤+Bmab療法を間隔を空けて施行し,長期病勢制御している症例を経験したので報告する。症例は73歳,女性。2014年他院にて,肝,肺転移を伴う直腸癌[Rb,T3,M1b(肝,肺),cStage Ⅳ]と診断され,conversion手術も考慮し化学療法(mFOLFOX6+Bmab)を開始した。5コース終了後,前医より紹介,転医となった。通算9コース終了後に評価したところ,原発巣と肺の病変が消失,肝転移1か所のみとなった。化学療法休薬をめざし,肝部分切除術を行った。術後休薬し,6か月後に直腸病変の再燃,肺転移の再燃を認めたが,原発巣制御目的に腹腔鏡下直腸切断術を施行した。さらに休薬を継続したが,直腸切断術後5か月のCT検査で肝転移と肺転移の増大を認めたため,化学療法再開とした(化学療法を15か月休薬)。しかしオキサリプラチン再導入は拒否したため,FU単剤+Bmabを選択した。再開後2か月で転移巣は縮小し,腫瘍マーカー値は正常化した。以後月に1回同療法を継続し,17か月PRを維持している(infusional 5-FU/LV+Bmab 18コース)。
目次
We herein report a Stage Ⅳ case of rectal cancer in a patient who achieved stable disease and was treated monthly with fluorouracil(FU)monotherapy plus bevacizumab(Bmab)against relapse after residual tumor resection and withdrawal because of refusal to continue chemotherapy, even though a marked response was obtained with standard chemotherapy. A 73-year-old woman visited a former hospital in 2014, and was diagnosed with rectal cancer with liver and lung metastases(diagnosed with Rb, T3, M1b[liver, lung]cStage Ⅳ). Chemotherapy(mFOLFOX6 plus Bmab)was initiated with a consideration of conversion. After 5 courses, she moved to our hospital. Since she was not aggressive to chemotherapy from the beginning, an imaging examination was performed after 9 courses. The primary lesion and lung metastases had disappeared, and there was only one liver metastasis. Partial hepatic resection was performed to attempt chemotherapy withdrawal following informed consent. Six months after surgery with no therapy, since relapse in the rectum and lungs was confirmed, laparoscopic rectal amputation was performed to control the primary tumor. Chemotherapy containing FU monotherapy plus Bmab was reinitiated after 15 months of withdrawal because liver and lung metastases increased 5 months after rectal amputation. Two months after resuming chemotherapy, the metastatic lesion decreased in size, and the tumor marker level normalized. The same regimen is continued monthly, and the response has been maintained for 17 months(infusions of 5-FU/LV plus Bmab, 18 courses).
要旨
今回われわれは,標準治療が奏効するも治療を半ば拒否する症例に対し残存腫瘍切除と休薬を行い,再燃後にFU単剤+Bmab療法を間隔を空けて施行し,長期病勢制御している症例を経験したので報告する。症例は73歳,女性。2014年他院にて,肝,肺転移を伴う直腸癌[Rb,T3,M1b(肝,肺),cStage Ⅳ]と診断され,conversion手術も考慮し化学療法(mFOLFOX6+Bmab)を開始した。5コース終了後,前医より紹介,転医となった。通算9コース終了後に評価したところ,原発巣と肺の病変が消失,肝転移1か所のみとなった。化学療法休薬をめざし,肝部分切除術を行った。術後休薬し,6か月後に直腸病変の再燃,肺転移の再燃を認めたが,原発巣制御目的に腹腔鏡下直腸切断術を施行した。さらに休薬を継続したが,直腸切断術後5か月のCT検査で肝転移と肺転移の増大を認めたため,化学療法再開とした(化学療法を15か月休薬)。しかしオキサリプラチン再導入は拒否したため,FU単剤+Bmabを選択した。再開後2か月で転移巣は縮小し,腫瘍マーカー値は正常化した。以後月に1回同療法を継続し,17か月PRを維持している(infusional 5-FU/LV+Bmab 18コース)。