内容紹介
Summary
Primary small bowel cancer is a rare entity; thus, it is often found in progress. Therefore, the prognosis is often poor. Because of its low frequency, there are few reports concerning the treatment for small bowel cancer; hence, it is important to examine individual cases in detail. In this study, we present a case of recurrent small bowel cancer that successfully responded to chemoradiation therapy. Case: A 48-year-old woman had anemia. Colonoscopy showed a tumor in the terminal ileum. Because of invasion in the ovaries and uterus, ileocecal resection, hysterectomy, and bilateral adnexectomy were performed. The pathological diagnosis was small bowel cancer with lymph node metastasis, and CapeOX therapy was administered as postoperative adjuvant chemotherapy. Since local recurrence was detected in the right lower quadrant 6 months after the surgery, IRIS plus BV was initiated. Radiation therapy(2 Gy×25 times, total 50 Gy)was also administered within the same period(only S-1 administration during radiation). After radiation therapy, the tumor decreased significantly in size and showed CR. Currently, the patient is under observation without treatment, but she has had no recurrence for 6 years after the confirmation of recurrence(6 years and 6 months after surgery). It is extremely rare for chemoradiation therapy to be effective for recurrent small bowel cancer; we report such a case with literatures.
要旨
原発性小腸癌は低頻度であり,かつ検査の困難性より進行状態で発見されることが多く,予後は不良である。そして低頻度であるがためにまとまった治療方針の報告が少なく,個々の症例を詳細に検討することが重要となる。今回,外科的切除後の再発に対して,放射線化学療法が有効であった原発性小腸癌の1例を提示して検討する。症例は48歳,女性。貧血精査の大腸内視鏡検査で回腸末端部に腫瘍を指摘された。卵巣,子宮への浸潤を認めたため,回盲部切除術,子宮全摘術,両側付属器切除術を行った。病理診断でリンパ節転移を伴った小腸癌の診断に至り術後補助化学療法としてCapeOX療法を施行した。術後6か月のCTで右下腹部に局所再発を認めたため,irinotecan+S-1+bevacizumab療法を開始した。同期間内に放射線治療(2 Gy×25回の全50 Gy)も併用(放射線治療中はS-1のみ)した。放射線化学療法後には腫瘍は著明に縮小しCRとなった。現在無治療で経過観察中であるが,再発確認後の6年現在(手術後6年6か月)再発は認めていない。小腸癌の再発症例に対して,放射線化学療法が奏効した症例は非常にまれであり報告する。
目次
Primary small bowel cancer is a rare entity; thus, it is often found in progress. Therefore, the prognosis is often poor. Because of its low frequency, there are few reports concerning the treatment for small bowel cancer; hence, it is important to examine individual cases in detail. In this study, we present a case of recurrent small bowel cancer that successfully responded to chemoradiation therapy. Case: A 48-year-old woman had anemia. Colonoscopy showed a tumor in the terminal ileum. Because of invasion in the ovaries and uterus, ileocecal resection, hysterectomy, and bilateral adnexectomy were performed. The pathological diagnosis was small bowel cancer with lymph node metastasis, and CapeOX therapy was administered as postoperative adjuvant chemotherapy. Since local recurrence was detected in the right lower quadrant 6 months after the surgery, IRIS plus BV was initiated. Radiation therapy(2 Gy×25 times, total 50 Gy)was also administered within the same period(only S-1 administration during radiation). After radiation therapy, the tumor decreased significantly in size and showed CR. Currently, the patient is under observation without treatment, but she has had no recurrence for 6 years after the confirmation of recurrence(6 years and 6 months after surgery). It is extremely rare for chemoradiation therapy to be effective for recurrent small bowel cancer; we report such a case with literatures.
要旨
原発性小腸癌は低頻度であり,かつ検査の困難性より進行状態で発見されることが多く,予後は不良である。そして低頻度であるがためにまとまった治療方針の報告が少なく,個々の症例を詳細に検討することが重要となる。今回,外科的切除後の再発に対して,放射線化学療法が有効であった原発性小腸癌の1例を提示して検討する。症例は48歳,女性。貧血精査の大腸内視鏡検査で回腸末端部に腫瘍を指摘された。卵巣,子宮への浸潤を認めたため,回盲部切除術,子宮全摘術,両側付属器切除術を行った。病理診断でリンパ節転移を伴った小腸癌の診断に至り術後補助化学療法としてCapeOX療法を施行した。術後6か月のCTで右下腹部に局所再発を認めたため,irinotecan+S-1+bevacizumab療法を開始した。同期間内に放射線治療(2 Gy×25回の全50 Gy)も併用(放射線治療中はS-1のみ)した。放射線化学療法後には腫瘍は著明に縮小しCRとなった。現在無治療で経過観察中であるが,再発確認後の6年現在(手術後6年6か月)再発は認めていない。小腸癌の再発症例に対して,放射線化学療法が奏効した症例は非常にまれであり報告する。