内容紹介
Summary
A 64-year-old woman who received neo-adjuvant chemotherapy and human epidermal growth factor receptor 2(HER2)-targeted therapy underwent modified radical mastectomy and axillary lymph node resection for HER2-positive right breast cancer. After the surgery, chemotherapy, post-mastectomy radiation therapy, and HER2-targeted therapy were administered as adjuvant therapies. Two years and 6 months postoperatively, she complained of headaches and nausea. Magnetic resonance imaging showed brain metastasis, which was treated with gamma knife surgery. Two weeks later, she was urgently admitted to the hospital because of impaired consciousness. Based on cerebrospinal fluid cytology, she was diagnosed with meningeal metastasis of breast cancer. She developed hydrocephalus; thus, external ventricular drainage was performed, and a ventriculoperitoneal shunt was inserted. She was treated with whole-brain irradiation(30 Gy)and trastuzumab emtansine(T-DM1)as systemic therapy. Treatment of the patient was possible without recurrence continuously for over 12 months and with the maintenance of daily activities. The prognosis of patients with meningeal metastasis of breast cancer is extremely poor, and effective pharmacotherapy has not yet been established. T-DM1 may improve patients' quality of life and the clinical outcomes of meningeal metastasis.
要旨
症例は64歳,女性。右乳癌(HER2陽性)にて右乳房切除術および腋窩リンパ節郭清術を施行した。術後2年6か月で頭痛・嘔気が出現,頭部造影MRI検査で脳転移と診断し,ガンマナイフ治療を施行した。治療後も嘔気が続き2週間後に意識が消失したため,再び頭部造影MRI検査を施行した。脳室の拡大がみられたため脳室-腹腔(V-P)シャント術を施行した。また,髄液検査で髄膜播種と診断し,全脳照射(30 Gy)および全身薬物療法としてトラスツズマブエムタンシン(T-DM1)を投与した。患者は生活の質(QOL)を維持したまま新規再発なく,12か月にわたって治療継続可能であった。乳癌髄膜播種の予後は不良であり,有用な薬物療法は確立されていない。T-DM1は,良好なQOLを保ったまま長期投与可能な選択肢となり得る。
目次
A 64-year-old woman who received neo-adjuvant chemotherapy and human epidermal growth factor receptor 2(HER2)-targeted therapy underwent modified radical mastectomy and axillary lymph node resection for HER2-positive right breast cancer. After the surgery, chemotherapy, post-mastectomy radiation therapy, and HER2-targeted therapy were administered as adjuvant therapies. Two years and 6 months postoperatively, she complained of headaches and nausea. Magnetic resonance imaging showed brain metastasis, which was treated with gamma knife surgery. Two weeks later, she was urgently admitted to the hospital because of impaired consciousness. Based on cerebrospinal fluid cytology, she was diagnosed with meningeal metastasis of breast cancer. She developed hydrocephalus; thus, external ventricular drainage was performed, and a ventriculoperitoneal shunt was inserted. She was treated with whole-brain irradiation(30 Gy)and trastuzumab emtansine(T-DM1)as systemic therapy. Treatment of the patient was possible without recurrence continuously for over 12 months and with the maintenance of daily activities. The prognosis of patients with meningeal metastasis of breast cancer is extremely poor, and effective pharmacotherapy has not yet been established. T-DM1 may improve patients' quality of life and the clinical outcomes of meningeal metastasis.
要旨
症例は64歳,女性。右乳癌(HER2陽性)にて右乳房切除術および腋窩リンパ節郭清術を施行した。術後2年6か月で頭痛・嘔気が出現,頭部造影MRI検査で脳転移と診断し,ガンマナイフ治療を施行した。治療後も嘔気が続き2週間後に意識が消失したため,再び頭部造影MRI検査を施行した。脳室の拡大がみられたため脳室-腹腔(V-P)シャント術を施行した。また,髄液検査で髄膜播種と診断し,全脳照射(30 Gy)および全身薬物療法としてトラスツズマブエムタンシン(T-DM1)を投与した。患者は生活の質(QOL)を維持したまま新規再発なく,12か月にわたって治療継続可能であった。乳癌髄膜播種の予後は不良であり,有用な薬物療法は確立されていない。T-DM1は,良好なQOLを保ったまま長期投与可能な選択肢となり得る。