内容紹介
Summary
We report the case of a 60-year-old woman with right breast cancer. Approximately 18 years had passed since the treatment for left breast cancer without recurrence. She became aware of the right breast tumor with mild pain 5 months before she came to the hospital. The diagnosis was right-sided breast cancer, cT2N0M0, StageⅡA, ER(-), PgR(-), HER2(-). Neoadjuvant chemotherapy was chosen, and then combined treatment with epirubicin(EPI)and cyclophosphamide(CPA)was started. The breast tumor had become smaller, but she complained of shortness of breath during the third course of chemotherapy. On the basis of her history of cancer onset, chest CT findings, and increase in serum SP-D levels, the combined therapy with EPI and CPA was suspected as the cause of the drug-induced interstitial lung disease(DILD). For this reason, the therapy was discontinued. After her recovery from this state, the operation(partial mastectomy and sentinel lymph node biopsy)was performed. S-1 was used as postoperative adjuvant therapy, and the respiratory symptoms did not recur or worsen. On the basis of the disease course, we made a diagnosis of DILD with EPI and CPA. Many anticancer drugs may cause DILD. In case of a suspicion of DILD onset, a prompt diagnosis and an appropriate treatment are important.
要旨
症例は60歳,女性。約18年前に左乳癌治療歴あり。転移再発なく経過していたが,約5か月前に右乳房の有痛性腫瘤を自覚し受診した。精査で右乳癌,cT2N0M0,StageⅡA,ER(-),PgR(-),HER2(-)の診断で抗癌剤化学療法後切除の方針となり,epirubicin(EPI)+cyclophosphamide(CPA)(EC療法)を開始した。腫瘤は縮小傾向であったが,3コース目受診時に息切れを訴えた。臨床症状,CT所見,血清SP-D値の上昇より薬剤性肺障害(drug-induced interstitial lung disease: DILD)と診断した。EC療法は中止し,状態の回復後に手術を施行(Bp+SN)した。術後S-1を投与し経過観察中であるが肺障害の再燃,増悪は認めていない。EC療法がDILDの誘因と思われた。DILDは,多くの抗癌剤で起こり得る合併症である。患者の状態よりDILDの併発を疑った場合には,迅速な診断と適切な対処が重要である。
目次
We report the case of a 60-year-old woman with right breast cancer. Approximately 18 years had passed since the treatment for left breast cancer without recurrence. She became aware of the right breast tumor with mild pain 5 months before she came to the hospital. The diagnosis was right-sided breast cancer, cT2N0M0, StageⅡA, ER(-), PgR(-), HER2(-). Neoadjuvant chemotherapy was chosen, and then combined treatment with epirubicin(EPI)and cyclophosphamide(CPA)was started. The breast tumor had become smaller, but she complained of shortness of breath during the third course of chemotherapy. On the basis of her history of cancer onset, chest CT findings, and increase in serum SP-D levels, the combined therapy with EPI and CPA was suspected as the cause of the drug-induced interstitial lung disease(DILD). For this reason, the therapy was discontinued. After her recovery from this state, the operation(partial mastectomy and sentinel lymph node biopsy)was performed. S-1 was used as postoperative adjuvant therapy, and the respiratory symptoms did not recur or worsen. On the basis of the disease course, we made a diagnosis of DILD with EPI and CPA. Many anticancer drugs may cause DILD. In case of a suspicion of DILD onset, a prompt diagnosis and an appropriate treatment are important.
要旨
症例は60歳,女性。約18年前に左乳癌治療歴あり。転移再発なく経過していたが,約5か月前に右乳房の有痛性腫瘤を自覚し受診した。精査で右乳癌,cT2N0M0,StageⅡA,ER(-),PgR(-),HER2(-)の診断で抗癌剤化学療法後切除の方針となり,epirubicin(EPI)+cyclophosphamide(CPA)(EC療法)を開始した。腫瘤は縮小傾向であったが,3コース目受診時に息切れを訴えた。臨床症状,CT所見,血清SP-D値の上昇より薬剤性肺障害(drug-induced interstitial lung disease: DILD)と診断した。EC療法は中止し,状態の回復後に手術を施行(Bp+SN)した。術後S-1を投与し経過観察中であるが肺障害の再燃,増悪は認めていない。EC療法がDILDの誘因と思われた。DILDは,多くの抗癌剤で起こり得る合併症である。患者の状態よりDILDの併発を疑った場合には,迅速な診断と適切な対処が重要である。