内容紹介
Summary
We reported the long-term survival of a patient who underwent multidisciplinary treatments for non-curative resected rectal mucinous carcinoma that occurred 20 years after rectal carcinoma surgery. A 69-year-old man who had undergone a lower anterior resection for rectal cancer diagnosed approximately 20 years prior was referred to our hospital with a diagnosis of rectal cancer. The tumor was detected near the rectal anastomosis of the previous surgery. Histopathologic study of the biopsy specimen revealed mucinous carcinoma. We performed a Miles operation in July 2010. The pathological findings were mucinous carcinoma, pT4b(small intestine), pN0, pPM1, pDM0, pRM1. Two months after surgery, chemotherapy comprising mFOLFOX6 plus Pmab was started and 12 courses of treatment were administrated. Then, UFT was orally administrated. The pelvic tumor gradually increased to 9 cm in diameter. Radiation therapy was performed from May 2013 but was not effective. The histopathologic findings of a CT-guided biopsy revealed mucin only. We administered oral S-1, but his serum CEA level increased to 30.7 ng/mL and skin invasion of the tumor was observed; therefore, we performed tumor reduction surgery through an incision from the perineum in July 2015. After surgery, regorafenib was administered. The serum CEA value was normalized, but repeated urinary tract infection, gradually deteriorated renal function, and local cancer progression were observed. Administration of regorafenib continued in an outpatient setting for approximately 2 years and 4 months. The patient was admitted to the hospital because his general condition deteriorated in February 2018 and he died in March 2018. We experienced a case that survived for more than 5 years and 6 months after the pelvic recurrence of the rectal mucinous carcinoma.
要旨
症例は69歳,男性。20年前に他院にて直腸癌の診断で低位前方切除術を施行した。下血を主訴に来院し,内視鏡検査にて直腸吻合部近傍に2型の腫瘍が見つかり,生検で粘液癌の所見であった。2010年7月にMiles手術,小腸合併切除術を施行した。病理組織学的所見は粘液癌,5×4 cm,pT4b(小腸),pN0,pPM1,pDM0,pRM1。術後2か月目からmFOLFOX6+Pmabを12コース施行した。その後UFTを300 mg内服し経過をみていたが,骨盤腔内の腫瘍は徐々に増大し径9 cmまで増大したため,2013年5月から放射線照射(50 Gy)をしたが縮小傾向はなかった。CTガイド下生検の病理組織学的所見はmucinのみであった。S-1内服にて経過をみていたが,2015年6月CEA 30.7 ng/mLと上昇,会陰創部は腫大し皮膚にも浸潤性の発赤を認めた。2015年7月会陰部から切開(非開腹)して可及的に腫瘍減量手術を施行した。術後はregorafenibを投与した。CEAは正常化していたが,その後尿路感染を繰り返し徐々に腎機能が悪化し,局所は進行増悪していった。regorafenibは約2年4か月間外来で投与を継続した。2018年2月に全身状態が悪化し入院し,2018年3月に死亡した。直腸粘液癌に対し再発治療に難渋しながらも,小骨盤内再発から5年6か月にわたり生存した症例を経験した。
目次
We reported the long-term survival of a patient who underwent multidisciplinary treatments for non-curative resected rectal mucinous carcinoma that occurred 20 years after rectal carcinoma surgery. A 69-year-old man who had undergone a lower anterior resection for rectal cancer diagnosed approximately 20 years prior was referred to our hospital with a diagnosis of rectal cancer. The tumor was detected near the rectal anastomosis of the previous surgery. Histopathologic study of the biopsy specimen revealed mucinous carcinoma. We performed a Miles operation in July 2010. The pathological findings were mucinous carcinoma, pT4b(small intestine), pN0, pPM1, pDM0, pRM1. Two months after surgery, chemotherapy comprising mFOLFOX6 plus Pmab was started and 12 courses of treatment were administrated. Then, UFT was orally administrated. The pelvic tumor gradually increased to 9 cm in diameter. Radiation therapy was performed from May 2013 but was not effective. The histopathologic findings of a CT-guided biopsy revealed mucin only. We administered oral S-1, but his serum CEA level increased to 30.7 ng/mL and skin invasion of the tumor was observed; therefore, we performed tumor reduction surgery through an incision from the perineum in July 2015. After surgery, regorafenib was administered. The serum CEA value was normalized, but repeated urinary tract infection, gradually deteriorated renal function, and local cancer progression were observed. Administration of regorafenib continued in an outpatient setting for approximately 2 years and 4 months. The patient was admitted to the hospital because his general condition deteriorated in February 2018 and he died in March 2018. We experienced a case that survived for more than 5 years and 6 months after the pelvic recurrence of the rectal mucinous carcinoma.
要旨
症例は69歳,男性。20年前に他院にて直腸癌の診断で低位前方切除術を施行した。下血を主訴に来院し,内視鏡検査にて直腸吻合部近傍に2型の腫瘍が見つかり,生検で粘液癌の所見であった。2010年7月にMiles手術,小腸合併切除術を施行した。病理組織学的所見は粘液癌,5×4 cm,pT4b(小腸),pN0,pPM1,pDM0,pRM1。術後2か月目からmFOLFOX6+Pmabを12コース施行した。その後UFTを300 mg内服し経過をみていたが,骨盤腔内の腫瘍は徐々に増大し径9 cmまで増大したため,2013年5月から放射線照射(50 Gy)をしたが縮小傾向はなかった。CTガイド下生検の病理組織学的所見はmucinのみであった。S-1内服にて経過をみていたが,2015年6月CEA 30.7 ng/mLと上昇,会陰創部は腫大し皮膚にも浸潤性の発赤を認めた。2015年7月会陰部から切開(非開腹)して可及的に腫瘍減量手術を施行した。術後はregorafenibを投与した。CEAは正常化していたが,その後尿路感染を繰り返し徐々に腎機能が悪化し,局所は進行増悪していった。regorafenibは約2年4か月間外来で投与を継続した。2018年2月に全身状態が悪化し入院し,2018年3月に死亡した。直腸粘液癌に対し再発治療に難渋しながらも,小骨盤内再発から5年6か月にわたり生存した症例を経験した。