内容紹介
Summary
A 54-year-old woman with unresectable multiple liver-limited metastases of rectal cancer was treated with cisplatin-based transcatheter arterial chemoembolization(TACE). Before initiating TACE, we performed abdominoperineal resection for advanced rectal cancer, resection of the bilateral ovaries for metastasis, liver resection for metastasis, and oxaliplatin/irinotecan/anti-EGFR chemotherapy for the unresectable liver metastases. For the liver-limited metastases that did not respond to systemic chemotherapy, we successfully controlled the disease in 26 months with TACE every 4 or 5 months. A combination of 50 mg cisplatin and 4 mL lipiodol was injected into the liver through the left or middle hepatic artery with a microcatheter via the femoral artery. The hepatic arteries were mildly embolized with Embosphere. Immediately after TACE, non-contrast-enhanced CT was performed to confirm the distribution of the cisplatin powder and embolization. Tumor response was assessed by enhanced CT 3 months after the treatment. We report a case of liver metastasis of colorectal cancer successfully controlled with cisplatin-based TACE over 2 years.
要旨
症例は54歳,女性。閉塞性直腸癌と同時性卵巣転移に対して人工肛門造設後,術前化学療法(CapeOX)を3か月行った後に直腸切断術および両側付属器切除術を施行した(R0切除)。3か月後の評価CTで肝転移再発(6か所)となり,肝切除で全病巣を摘出した。2か月後に再度肝転移再発を認め全身化学療法(FOLFIRI+bevacizumab)を開始したが,1か月半で不応となった。抗EGFR抗体薬+irinotecanで次治療を行ったが4か月後に不応となり,肝転移に対してシスプラチンを用いたtranscatheter arterial chemoembolization(TACE)を施行すると肝転移の病勢がコントロールされており,有効であると判断した。このためTACEを4～5か月に1回程度とし,途中から全身化学療法としてTAS-102+bevacizumabを併用しながら,2年間で合計5回施行した。今回われわれは,約2年にわたり大腸癌肝転移に対してシスプラチン粒子を用いたTACEを行い病巣コントロールが可能であった症例を経験したので報告する。
目次
A 54-year-old woman with unresectable multiple liver-limited metastases of rectal cancer was treated with cisplatin-based transcatheter arterial chemoembolization(TACE). Before initiating TACE, we performed abdominoperineal resection for advanced rectal cancer, resection of the bilateral ovaries for metastasis, liver resection for metastasis, and oxaliplatin/irinotecan/anti-EGFR chemotherapy for the unresectable liver metastases. For the liver-limited metastases that did not respond to systemic chemotherapy, we successfully controlled the disease in 26 months with TACE every 4 or 5 months. A combination of 50 mg cisplatin and 4 mL lipiodol was injected into the liver through the left or middle hepatic artery with a microcatheter via the femoral artery. The hepatic arteries were mildly embolized with Embosphere. Immediately after TACE, non-contrast-enhanced CT was performed to confirm the distribution of the cisplatin powder and embolization. Tumor response was assessed by enhanced CT 3 months after the treatment. We report a case of liver metastasis of colorectal cancer successfully controlled with cisplatin-based TACE over 2 years.
要旨
症例は54歳,女性。閉塞性直腸癌と同時性卵巣転移に対して人工肛門造設後,術前化学療法(CapeOX)を3か月行った後に直腸切断術および両側付属器切除術を施行した(R0切除)。3か月後の評価CTで肝転移再発(6か所)となり,肝切除で全病巣を摘出した。2か月後に再度肝転移再発を認め全身化学療法(FOLFIRI+bevacizumab)を開始したが,1か月半で不応となった。抗EGFR抗体薬+irinotecanで次治療を行ったが4か月後に不応となり,肝転移に対してシスプラチンを用いたtranscatheter arterial chemoembolization(TACE)を施行すると肝転移の病勢がコントロールされており,有効であると判断した。このためTACEを4～5か月に1回程度とし,途中から全身化学療法としてTAS-102+bevacizumabを併用しながら,2年間で合計5回施行した。今回われわれは,約2年にわたり大腸癌肝転移に対してシスプラチン粒子を用いたTACEを行い病巣コントロールが可能であった症例を経験したので報告する。