内容紹介
Summary
We report a case of peritoneal dissemination of gastric cancer in which the QOL was maintained with a less-than-optimum dose of anticancer agent. A 64-year-old man underwent total gastrectomy for corpus gastric cancer without distant metastasis performed as an open-laparotomy. Peritoneum disseminations were observed in the left sub-diaphragmatic space and back side of the mesocolon, and the tumor passed directly to the superior mesenteric vein of transverse mesocolon. As a first-line chemotherapy, G-SOX therapy(S-1 80 mg/day/body and oxaliplatin 100 mg/m2)was administered for 15 courses. After these courses, the disease was categorized as PD. Next, RAM/PTX(ramucirumab 8 mg/kg and paclitaxel 80 mg/m2)were administered as second-line chemotherapy. However, the PTX, especially caused prolonged adverse effects such as G4-leveled blood toxicity and severe general fatigue. Therefore, we administered a lower dose of PTX than the original optimal minimum dose. This lower dose chemotherapy resulted in effective changes such as decreased pain and general fatigue and resolution of the blood toxicity. As a result, the patient's QOL improved, and his condition has been maintained as SD for 2 years after the operation. For these reasons, this ordinary chemotherapy may be used as a palliative chemotherapy.
要旨
胃癌腹膜播種に対して抗癌剤至適投与量を下回る投与量でもQOL維持が図れ,病状も安定している1例について報告する。症例は64歳,男性。進行胃体部癌に対して胃全摘術予定であったがダグラス窩洗浄細胞診が陽性であり,左横隔膜下・結腸間膜裏面に腹膜播種を認め,さらに腫瘍は横行結腸間膜を貫き上腸間膜静脈にまで直接浸潤していたため切除不能であった。術後は胃癌治療ガイドラインに準じG-SOX療法から開始し,おおむね病状の改善・維持は図れていたがPDとなったためRAM/PTXに変更した。しかし変更後から繰り返すG3～G4レベルの血液毒性と,強い全身倦怠感に伴うQOLの低下を認めた。減量・休薬にもかかわらず回復が悪いため,本来の至適最低投与量を下回る投与量に設定し化学療法を継続した。その結果,血液毒性を回避し,倦怠感も軽減できたことでQOLは良好に維持したまま,術後2年現在も病状は安定している。化学療法は緩和的な利用方法も可能ではないかと考えられた。
目次
We report a case of peritoneal dissemination of gastric cancer in which the QOL was maintained with a less-than-optimum dose of anticancer agent. A 64-year-old man underwent total gastrectomy for corpus gastric cancer without distant metastasis performed as an open-laparotomy. Peritoneum disseminations were observed in the left sub-diaphragmatic space and back side of the mesocolon, and the tumor passed directly to the superior mesenteric vein of transverse mesocolon. As a first-line chemotherapy, G-SOX therapy(S-1 80 mg/day/body and oxaliplatin 100 mg/m2)was administered for 15 courses. After these courses, the disease was categorized as PD. Next, RAM/PTX(ramucirumab 8 mg/kg and paclitaxel 80 mg/m2)were administered as second-line chemotherapy. However, the PTX, especially caused prolonged adverse effects such as G4-leveled blood toxicity and severe general fatigue. Therefore, we administered a lower dose of PTX than the original optimal minimum dose. This lower dose chemotherapy resulted in effective changes such as decreased pain and general fatigue and resolution of the blood toxicity. As a result, the patient's QOL improved, and his condition has been maintained as SD for 2 years after the operation. For these reasons, this ordinary chemotherapy may be used as a palliative chemotherapy.
要旨
胃癌腹膜播種に対して抗癌剤至適投与量を下回る投与量でもQOL維持が図れ,病状も安定している1例について報告する。症例は64歳,男性。進行胃体部癌に対して胃全摘術予定であったがダグラス窩洗浄細胞診が陽性であり,左横隔膜下・結腸間膜裏面に腹膜播種を認め,さらに腫瘍は横行結腸間膜を貫き上腸間膜静脈にまで直接浸潤していたため切除不能であった。術後は胃癌治療ガイドラインに準じG-SOX療法から開始し,おおむね病状の改善・維持は図れていたがPDとなったためRAM/PTXに変更した。しかし変更後から繰り返すG3～G4レベルの血液毒性と,強い全身倦怠感に伴うQOLの低下を認めた。減量・休薬にもかかわらず回復が悪いため,本来の至適最低投与量を下回る投与量に設定し化学療法を継続した。その結果,血液毒性を回避し,倦怠感も軽減できたことでQOLは良好に維持したまま,術後2年現在も病状は安定している。化学療法は緩和的な利用方法も可能ではないかと考えられた。