内容紹介
Summary
Combination therapy containing nab-paclitaxel(nab-PTX)and gemcitabine(GEM)is widely administered for metastatic pancreatic cancer. Recently, this regimen is likely to be applied for treatment in patients with locally advanced disease or for neoadjuvant chemotherapy(NAC)in patients with borderline resectable(BR)pancreatic cancer. We report a case of BR pancreatic cancer in a patient who was eligible for comparison of the imaging findings with the microscopic findings of the resected specimen. A 72-year-old woman was admitted to our hospital with a complaint of jaundice. Enhanced CT showed a 35 mm tumor at the head of the pancreas involving the portal vein and in contact with the superior mesenteric artery(SMA). After 4 courses of chemotherapy containing a combination of nab-PTX and GEM, the tumor reduced in size, but was still in contact with the portal vein and SMA on imaging. The level of tumor marker CA19-9 was remarkably reduced. Subtotal stomach-preserving pancreaticoduodenectomy with portal vein reconstruction was performed. Macroscopic findings of the cut surface of the resected specimen showed that a white nodule at the pancreas head involved the portal vein and was in contact with the close-cut margin from the SMA; however, microscopic findings revealed that tumor cells had disappeared in the plexus around the SMA. R0 resection was achieved. The histological treatment effect based on Evans' classification and TNM classification were GradeⅡ and pT3N1aM0(pStageⅡB), respectively. There has been no recurrence 15 months after the surgery. Based on the abovementioned findings, chemotherapy containing a combination of nab-PTX and GEM can be an effective option of NAC for BR-A pancreatic cancer. Even if the tumor is in contact with the SMA on imaging, when the CA19-9 level is markedly reduced, there is a possibility of achieving R0 surgery.
要旨
borderline resectable膵癌(BR-A膵癌)に対して術前化学療法(NAC)を施行し,R0手術を行い得たので報告する。症例は72歳,女性。食思不振を主訴に受診し,閉塞性黄疸,CA19-9高値,造影CTで膵頭部に35 mm大の腫瘍を認めた。SMAに180度未満の接触があり,BR-A膵癌と診断した。減黄後,gemcitabine(GEM)+nab-paclitaxel(nab-PTX)によるNACを行いCA19-9は著明に低下し,造影CTで腫瘍縮小効果を認めたことから手術を施行した。CT像と対比させた腫瘍を含む割面では肉眼的に腫瘍が浸潤しPLsmaにも及んでいたが,顕微鏡的にはviable cellを認めず,R0手術であった。組織学的治療効果はGradeⅡ,最終診断はpT3,pN1a,pM0,pStageⅡBであった。GEM+nab-PTX療法は,BR-A膵癌に対するNACの一選択肢になり,画像上動脈系への浸潤を認めていても全体に腫瘍が縮小しCA19-9が著減した場合はR0手術を達成し得る可能性があることが示唆された。
目次
Combination therapy containing nab-paclitaxel(nab-PTX)and gemcitabine(GEM)is widely administered for metastatic pancreatic cancer. Recently, this regimen is likely to be applied for treatment in patients with locally advanced disease or for neoadjuvant chemotherapy(NAC)in patients with borderline resectable(BR)pancreatic cancer. We report a case of BR pancreatic cancer in a patient who was eligible for comparison of the imaging findings with the microscopic findings of the resected specimen. A 72-year-old woman was admitted to our hospital with a complaint of jaundice. Enhanced CT showed a 35 mm tumor at the head of the pancreas involving the portal vein and in contact with the superior mesenteric artery(SMA). After 4 courses of chemotherapy containing a combination of nab-PTX and GEM, the tumor reduced in size, but was still in contact with the portal vein and SMA on imaging. The level of tumor marker CA19-9 was remarkably reduced. Subtotal stomach-preserving pancreaticoduodenectomy with portal vein reconstruction was performed. Macroscopic findings of the cut surface of the resected specimen showed that a white nodule at the pancreas head involved the portal vein and was in contact with the close-cut margin from the SMA; however, microscopic findings revealed that tumor cells had disappeared in the plexus around the SMA. R0 resection was achieved. The histological treatment effect based on Evans' classification and TNM classification were GradeⅡ and pT3N1aM0(pStageⅡB), respectively. There has been no recurrence 15 months after the surgery. Based on the abovementioned findings, chemotherapy containing a combination of nab-PTX and GEM can be an effective option of NAC for BR-A pancreatic cancer. Even if the tumor is in contact with the SMA on imaging, when the CA19-9 level is markedly reduced, there is a possibility of achieving R0 surgery.
要旨
borderline resectable膵癌(BR-A膵癌)に対して術前化学療法(NAC)を施行し,R0手術を行い得たので報告する。症例は72歳,女性。食思不振を主訴に受診し,閉塞性黄疸,CA19-9高値,造影CTで膵頭部に35 mm大の腫瘍を認めた。SMAに180度未満の接触があり,BR-A膵癌と診断した。減黄後,gemcitabine(GEM)+nab-paclitaxel(nab-PTX)によるNACを行いCA19-9は著明に低下し,造影CTで腫瘍縮小効果を認めたことから手術を施行した。CT像と対比させた腫瘍を含む割面では肉眼的に腫瘍が浸潤しPLsmaにも及んでいたが,顕微鏡的にはviable cellを認めず,R0手術であった。組織学的治療効果はGradeⅡ,最終診断はpT3,pN1a,pM0,pStageⅡBであった。GEM+nab-PTX療法は,BR-A膵癌に対するNACの一選択肢になり,画像上動脈系への浸潤を認めていても全体に腫瘍が縮小しCA19-9が著減した場合はR0手術を達成し得る可能性があることが示唆された。