内容紹介
Summary
We report a case of liver metastasis of intrahepatic cholangiocarcinoma that achieved clinical complete response after gemcitabine(GEM)and cisplatin(CDDP)combination chemotherapy. The patient was a 69-year-old man who was diagnosed with intrahepatic cholangiocarcinoma with hilar invasion and intrahepatic metastasis(cT4N0M0, Stage ⅣA)and was initially treated with right trisegmentectomy with left portal vein resection, lymph node dissection, and reconstruction of the left portal vein and biliary tract after transhepatic portal vein embolization(PTPE). S-1 was administered continuously as postoperative adjuvant chemotherapy, and the patient showed no signs of recurrence. Three years after the surgery, a CT scan showed LDA 10 mm in diameter in the middle area of the remnant liver. We suspected liver metastasis when both serum CA19-9 and DUPAN-2 levels were elevated with the increasing size of LDA; liver biopsy was then performed, and he was diagnosed with liver metastasis of intrahepatic cholangiocarcinoma. After 3 courses of combination chemotherapy containing GEM and CDDP, a CT scan revealed that the liver metastasis reduced in size, and PR was achieved based on the RECIST standard. After 12 courses, the liver metastasis disappeared, and the patient had achieved CR based on the RECIST standard. The patient has received S-1 following the combination chemotherapy and survived for 6 years since initial treatment without any other metastatic lesions.
要旨
症例は69歳,男性。肝前区域を主座とし,肝内転移,肝門部浸潤を伴った肝内胆管癌のため,2012年7月PTPE後に肝右三区域切除および門脈合併切除,左肝管空腸吻合術を施行し,S-1(80 mg/body 2週投与1週休薬)による補助化学療法を施行し経過観察していた。術後3年のCTで肝S3に径1 cm大の辺縁が造影されるLDAを認めた。病変が小さく経過観察したが,CA19-9およびDUPAN-2が上昇しCTで腫瘍増大を認めたため肝生検を施行し肝転移と診断した。残肝深部にあり切除不能と判断し,2016年2月よりGC療法(GEM 1,000 mg/m2,CDDP 25 mg/m2 2週投与1週休薬)を開始した。3コース終了後のCTで,PRの腫瘍縮小効果と腫瘍マーカーの低下を認め治療を継続した。末【梢】神経障害が強くなった12コース終了時点のCTで肝転移巣は消失し,CRの腫瘍縮小効果を得た。末【梢】神経障害が軽減した後,S-1療法を再開し現在も治療継続中である。術後6年のCTでは肝転移巣は完全に消失し,CRを維持したまま経過観察中である。
目次
We report a case of liver metastasis of intrahepatic cholangiocarcinoma that achieved clinical complete response after gemcitabine(GEM)and cisplatin(CDDP)combination chemotherapy. The patient was a 69-year-old man who was diagnosed with intrahepatic cholangiocarcinoma with hilar invasion and intrahepatic metastasis(cT4N0M0, Stage ⅣA)and was initially treated with right trisegmentectomy with left portal vein resection, lymph node dissection, and reconstruction of the left portal vein and biliary tract after transhepatic portal vein embolization(PTPE). S-1 was administered continuously as postoperative adjuvant chemotherapy, and the patient showed no signs of recurrence. Three years after the surgery, a CT scan showed LDA 10 mm in diameter in the middle area of the remnant liver. We suspected liver metastasis when both serum CA19-9 and DUPAN-2 levels were elevated with the increasing size of LDA; liver biopsy was then performed, and he was diagnosed with liver metastasis of intrahepatic cholangiocarcinoma. After 3 courses of combination chemotherapy containing GEM and CDDP, a CT scan revealed that the liver metastasis reduced in size, and PR was achieved based on the RECIST standard. After 12 courses, the liver metastasis disappeared, and the patient had achieved CR based on the RECIST standard. The patient has received S-1 following the combination chemotherapy and survived for 6 years since initial treatment without any other metastatic lesions.
要旨
症例は69歳,男性。肝前区域を主座とし,肝内転移,肝門部浸潤を伴った肝内胆管癌のため,2012年7月PTPE後に肝右三区域切除および門脈合併切除,左肝管空腸吻合術を施行し,S-1(80 mg/body 2週投与1週休薬)による補助化学療法を施行し経過観察していた。術後3年のCTで肝S3に径1 cm大の辺縁が造影されるLDAを認めた。病変が小さく経過観察したが,CA19-9およびDUPAN-2が上昇しCTで腫瘍増大を認めたため肝生検を施行し肝転移と診断した。残肝深部にあり切除不能と判断し,2016年2月よりGC療法(GEM 1,000 mg/m2,CDDP 25 mg/m2 2週投与1週休薬)を開始した。3コース終了後のCTで,PRの腫瘍縮小効果と腫瘍マーカーの低下を認め治療を継続した。末【梢】神経障害が強くなった12コース終了時点のCTで肝転移巣は消失し,CRの腫瘍縮小効果を得た。末【梢】神経障害が軽減した後,S-1療法を再開し現在も治療継続中である。術後6年のCTでは肝転移巣は完全に消失し,CRを維持したまま経過観察中である。