内容紹介
Summary
A 66-year-old woman diagnosed with advanced Stage Ⅳ gastric cancer(T4aN3M1[LYM])received RAM plus wPTX as third-line chemotherapy(ramucirumab 8 mg/kg on the 1st and 15th day, paclitaxel 80 mg/m2 on the 1st, 8th, and 15th day). After receiving 3 courses of this treatment, para-aortic lymphadenopathy had diminished but anemia had progressed because of tumor hemorrhage. Six weeks after the last administration of RAM, an open distal gastrectomy with D1 plus lymph node dissection and Billroth Ⅰ reconstruction was performed. The patient was discharged on the 9th day after surgery without complications such as postoperative bleeding and delayed wound healing. RAM plus wPTX therapy was restarted 6 weeks after the operation. Postoperative late complication there is no adverse event including adenocarcinoma and continues the same therapy at present. The perioperative treatment under the use of angiogenesis inhibitor has risk of postoperative bleeding and wound healing delay and includes surgery timing of treatment may be difficult. In our case, surgery was performed 6 weeks after the final administration of RAM.
要旨
症例は66歳,女性。胃癌Stage Ⅳ[T4aN3M1(LYM)]に対してthird-lineのRAM+wPTX療法(ramucirumab 8mg/kg 1,15日目に投与,paclitaxel 80 mg/m2 1,8,15日目に投与)3コース終了時に腫瘍出血に伴う貧血の進行を認め,RAM最終投与から6週間目に開腹幽門側胃切除(D1+リンパ節郭清,BillrothⅠ法再建)を施行し,術後出血や創傷治癒遅延などの合併症なく術後9日目に軽快退院となった。その後,術後1か月後よりRAM+wPTX療法を再開することができた。血管新生阻害薬使用下での手術は術後出血や創傷治癒遅延のリスクがあり,手術を含めて治療のタイミング決定に難渋することがある。今回,RAM最終投与から6週間後に手術を行い,術後早期からRAMを再開できた1例を経験した。今後さらなる症例の集積により,周術期のRAM使用や安全性の検討が必要と考えられた。
目次
A 66-year-old woman diagnosed with advanced Stage Ⅳ gastric cancer(T4aN3M1[LYM])received RAM plus wPTX as third-line chemotherapy(ramucirumab 8 mg/kg on the 1st and 15th day, paclitaxel 80 mg/m2 on the 1st, 8th, and 15th day). After receiving 3 courses of this treatment, para-aortic lymphadenopathy had diminished but anemia had progressed because of tumor hemorrhage. Six weeks after the last administration of RAM, an open distal gastrectomy with D1 plus lymph node dissection and Billroth Ⅰ reconstruction was performed. The patient was discharged on the 9th day after surgery without complications such as postoperative bleeding and delayed wound healing. RAM plus wPTX therapy was restarted 6 weeks after the operation. Postoperative late complication there is no adverse event including adenocarcinoma and continues the same therapy at present. The perioperative treatment under the use of angiogenesis inhibitor has risk of postoperative bleeding and wound healing delay and includes surgery timing of treatment may be difficult. In our case, surgery was performed 6 weeks after the final administration of RAM.
要旨
症例は66歳,女性。胃癌Stage Ⅳ[T4aN3M1(LYM)]に対してthird-lineのRAM+wPTX療法(ramucirumab 8mg/kg 1,15日目に投与,paclitaxel 80 mg/m2 1,8,15日目に投与)3コース終了時に腫瘍出血に伴う貧血の進行を認め,RAM最終投与から6週間目に開腹幽門側胃切除(D1+リンパ節郭清,BillrothⅠ法再建)を施行し,術後出血や創傷治癒遅延などの合併症なく術後9日目に軽快退院となった。その後,術後1か月後よりRAM+wPTX療法を再開することができた。血管新生阻害薬使用下での手術は術後出血や創傷治癒遅延のリスクがあり,手術を含めて治療のタイミング決定に難渋することがある。今回,RAM最終投与から6週間後に手術を行い,術後早期からRAMを再開できた1例を経験した。今後さらなる症例の集積により,周術期のRAM使用や安全性の検討が必要と考えられた。