内容紹介
Summary
A 69-year-old man was administered S-1/oxaliplatin/trastuzumab as induction chemotherapy for advanced gastric cancer(cT4b[liver, pancreas], N2M1(H1P0CYX), cStage Ⅳ). After 4 courses, because contrast-enhanced computed tomography showed remarkable reduction of the tumor, distal gastrectomy, partial hepatectomy, and radiofrequency ablation for the liver metastasis were performed. The patient was histopathologically diagnosed with gastric neuroendocrine carcinoma(NEC). S-1/oxaliplatin/trastuzumab was continued after surgery; however, recurrence in the remnant liver was observed after 4 courses. For recurrence, cisplatin/irinotecan as first-line and paclitaxel/ramucirumab as second-line treatment were administered, but progression of liver metastasis and ascites due to peritoneal dissemination were observed. As third-line treatment, nivolumab was initiated. Ascites decreased after 3 courses, but after 2 more courses, progression of ascites, liver recurrence, and multiple metastasis in the lumbar vertebra were observed.
要旨
症例は69歳,男性。進行胃癌,L,Less,Ant,typeⅡ,tub/por,cT4b(肝・膵),N2M1(H1P0CYX),cStage Ⅳの診断の下,S-1/oxaliplatin/trastuzumab療法を施行した。4コース後,原発巣は縮小し根治切除可能と判断したため,幽門側胃切除術,肝(S3,S4,S6)部分切除術,肝(S3,S4)ラジオ波焼却術を施行した。切除標本の病理組織学的検査では,胃神経内分泌細胞癌(NEC)と診断された。術後S-1/oxaliplatin/trastuzumab療法を継続したが4コース後に残肝再発を認めた。再発に対してfirst-lineとして,cisplatin/irinotecan療法,second-lineとしてpaclitaxel/ramucirumab療法を施行するも肝転移は増悪し,腹膜播種による腹水が出現した。third-lineとしてnivolumabの投与を開始し,3コース終了した時点で腹水の減少を認めたが,さらに2コース追加したところ肝転移・腹水は増悪し腰椎多発骨転移を認めた。
目次
A 69-year-old man was administered S-1/oxaliplatin/trastuzumab as induction chemotherapy for advanced gastric cancer(cT4b[liver, pancreas], N2M1(H1P0CYX), cStage Ⅳ). After 4 courses, because contrast-enhanced computed tomography showed remarkable reduction of the tumor, distal gastrectomy, partial hepatectomy, and radiofrequency ablation for the liver metastasis were performed. The patient was histopathologically diagnosed with gastric neuroendocrine carcinoma(NEC). S-1/oxaliplatin/trastuzumab was continued after surgery; however, recurrence in the remnant liver was observed after 4 courses. For recurrence, cisplatin/irinotecan as first-line and paclitaxel/ramucirumab as second-line treatment were administered, but progression of liver metastasis and ascites due to peritoneal dissemination were observed. As third-line treatment, nivolumab was initiated. Ascites decreased after 3 courses, but after 2 more courses, progression of ascites, liver recurrence, and multiple metastasis in the lumbar vertebra were observed.
要旨
症例は69歳,男性。進行胃癌,L,Less,Ant,typeⅡ,tub/por,cT4b(肝・膵),N2M1(H1P0CYX),cStage Ⅳの診断の下,S-1/oxaliplatin/trastuzumab療法を施行した。4コース後,原発巣は縮小し根治切除可能と判断したため,幽門側胃切除術,肝(S3,S4,S6)部分切除術,肝(S3,S4)ラジオ波焼却術を施行した。切除標本の病理組織学的検査では,胃神経内分泌細胞癌(NEC)と診断された。術後S-1/oxaliplatin/trastuzumab療法を継続したが4コース後に残肝再発を認めた。再発に対してfirst-lineとして,cisplatin/irinotecan療法,second-lineとしてpaclitaxel/ramucirumab療法を施行するも肝転移は増悪し,腹膜播種による腹水が出現した。third-lineとしてnivolumabの投与を開始し,3コース終了した時点で腹水の減少を認めたが,さらに2コース追加したところ肝転移・腹水は増悪し腰椎多発骨転移を認めた。