内容紹介
Summary
A 59-year-old woman was diagnosed with advanced gastric cancer with para-aortic and Virchow's lymph node metastases(L, Less, type 2, tub1, cT3N2H0P0M1[LYM: #16, Virchow's]). Four courses of S-1(80 mg/m2, days 1-21)and CDDP(60 mg/m2, day 8)were administered. After the chemotherapy, CT showed that the primary tumor and para-aortic and Virchow's lymph nodes had reduced in size. The clinical stage was ycT3N1H0P0M0, stage ⅢA. The patient underwent distal gastrectomy, D2 dissection, and sampling of the para-aortic lymph nodes(#16b1lat, #16a2int). The pathological diagnosis was L, less, type 1, por1/2, pT2N2H0P0M0CY0, pStage ⅢB. The patient was treated with S-1(80 mg/m2, days 1-28)as adjuvant chemotherapy. After 3 courses had been administered(6 months after the resection), swelling of a para-aortic lymph node(#16b1int)was detected using CT. Based on the diagnosis of recurrence in the lymph node, weekly paclitaxel(80 mg/m2, days 1, 8, and 15)was administered. After receiving 9 courses of weekly paclitaxel, the swelling of the lymph node disappeared, and the response evaluation was complete response. She discontinued the chemotherapy 5 years and 9 months after the surgery. To date, she has survived more than 6 years after surgery without recurrence. We report a long-surviving patient with advanced gastric cancer with para-aortic lymph node metastasis who received combined modality therapy.
要旨
症例は59歳,女性。健康診断で異常所見を指摘され施行した上部消化管内視鏡で胃前庭小弯側に2型腫瘤を認め,当院へ紹介受診となった。精査で進行胃癌[L,less,type 2,tub1,cT3N2H0P0M1(LYM: #16,Virchow),Stage Ⅳ]と診断した。S-1(80 mg/m2,day 1～21)/CDDP(60 mg/m2,day 8)(3週投与2週休薬)を開始し,4コース施行後の評価でcT3N1H0P0M0,Stage ⅢAと判断した。開腹幽門側胃切除(D2郭清)およびB-Ⅰ再建+#16サンプリング(#16b1lat,#16a2int)を施行した。病理結果はL,less,type 1,por1/2,pT2N2H0P0M0CY0(#16b1lat,#16a2intにも転移を示す所見なし),pStage ⅢBであった。補助化学療法としてS-1(80 mg/m2,day 1～28)(4週投与2週休薬)を開始した。術後6か月(S-1 3コース施行後)のcomputed tomography(CT)で#16b1int腫大あり,リンパ節再発の診断でweekly paclitaxel(80 mg/m2,day 1,8,15)(3週投与1週休薬)に変更した。術後1年3か月(weekly paclitaxel 9コース施行後)の画像評価で腫大リンパ節は消失し,complete responseと判断した。術後5年9か月(weekly paclitaxel 54コース)まで施行し化学療法を中止した。術後6年0か月現在,無再発で外来通院中である。今回,傍大動脈リンパ節転移を伴う進行胃癌に対して集学的治療が奏効し長期生存を得られた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。
目次
A 59-year-old woman was diagnosed with advanced gastric cancer with para-aortic and Virchow's lymph node metastases(L, Less, type 2, tub1, cT3N2H0P0M1[LYM: #16, Virchow's]). Four courses of S-1(80 mg/m2, days 1-21)and CDDP(60 mg/m2, day 8)were administered. After the chemotherapy, CT showed that the primary tumor and para-aortic and Virchow's lymph nodes had reduced in size. The clinical stage was ycT3N1H0P0M0, stage ⅢA. The patient underwent distal gastrectomy, D2 dissection, and sampling of the para-aortic lymph nodes(#16b1lat, #16a2int). The pathological diagnosis was L, less, type 1, por1/2, pT2N2H0P0M0CY0, pStage ⅢB. The patient was treated with S-1(80 mg/m2, days 1-28)as adjuvant chemotherapy. After 3 courses had been administered(6 months after the resection), swelling of a para-aortic lymph node(#16b1int)was detected using CT. Based on the diagnosis of recurrence in the lymph node, weekly paclitaxel(80 mg/m2, days 1, 8, and 15)was administered. After receiving 9 courses of weekly paclitaxel, the swelling of the lymph node disappeared, and the response evaluation was complete response. She discontinued the chemotherapy 5 years and 9 months after the surgery. To date, she has survived more than 6 years after surgery without recurrence. We report a long-surviving patient with advanced gastric cancer with para-aortic lymph node metastasis who received combined modality therapy.
要旨
症例は59歳,女性。健康診断で異常所見を指摘され施行した上部消化管内視鏡で胃前庭小弯側に2型腫瘤を認め,当院へ紹介受診となった。精査で進行胃癌[L,less,type 2,tub1,cT3N2H0P0M1(LYM: #16,Virchow),Stage Ⅳ]と診断した。S-1(80 mg/m2,day 1～21)/CDDP(60 mg/m2,day 8)(3週投与2週休薬)を開始し,4コース施行後の評価でcT3N1H0P0M0,Stage ⅢAと判断した。開腹幽門側胃切除(D2郭清)およびB-Ⅰ再建+#16サンプリング(#16b1lat,#16a2int)を施行した。病理結果はL,less,type 1,por1/2,pT2N2H0P0M0CY0(#16b1lat,#16a2intにも転移を示す所見なし),pStage ⅢBであった。補助化学療法としてS-1(80 mg/m2,day 1～28)(4週投与2週休薬)を開始した。術後6か月(S-1 3コース施行後)のcomputed tomography(CT)で#16b1int腫大あり,リンパ節再発の診断でweekly paclitaxel(80 mg/m2,day 1,8,15)(3週投与1週休薬)に変更した。術後1年3か月(weekly paclitaxel 9コース施行後)の画像評価で腫大リンパ節は消失し,complete responseと判断した。術後5年9か月(weekly paclitaxel 54コース)まで施行し化学療法を中止した。術後6年0か月現在,無再発で外来通院中である。今回,傍大動脈リンパ節転移を伴う進行胃癌に対して集学的治療が奏効し長期生存を得られた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。