内容紹介
Summary
A 60-year-old woman underwent intersphincteric resection for lower rectal cancer in 2016. The pathological stage was pT3N1M0, stage Ⅲa and the cancer was curatively resected. Local recurrence was detected 6 months after the surgery. The patient received chemotherapy of 4 courses of FOLFOXIRI plus bevacizumab(Bev). A Grade 4 adverse event(febrile neutropenia)occurred but the treatment was continued after a dose reduction to 80%. The size of the tumor decreased significantly after chemotherapy and posterior pelvic exenteration with sacral resection was performed. Pathological analysis revealed a positive radial margin but there were no remarkable complications after surgery and no obvious recurrence during the 9 months after the operation. Therefore, we concluded that FOLFOXIRI plus Bev chemotherapy is a manageable and useful treatment for locally recurrent rectal cancer.
要旨
症例は60歳,女性。下部直腸癌に対し術前補助化学療法後,開腹ISR,両側側方リンパ節郭清を行った。病理結果はpT3N1M0でR0手術となった。術後6か月で直腸後腔に局所再発を認め,一期的切除も検討したが切除困難が予想されたため,FOLFOXIRI+bevacizumab(Bev)療法を4コース施行した。有害事象としてGrade 4の発熱性好中球減少を認めたが,減量にて継続可能であった。腫瘍は著明に縮小し遠隔転移を認めず,切除可能と判断し開腹後方骨盤内臓全摘仙骨合併切除術を施行した。病理結果ではR1であったが外科的に一塊に切除でき,欠損部への皮弁も必要とせず,術後も大きな合併症は認めなかった。現在術後9か月にて再発所見なく経過中である。FOLFOXIRI+Bev療法は症例を選べば有害事象も管理可能な範囲であり,奏効率も高く有用な治療選択肢と考えられた。
目次
A 60-year-old woman underwent intersphincteric resection for lower rectal cancer in 2016. The pathological stage was pT3N1M0, stage Ⅲa and the cancer was curatively resected. Local recurrence was detected 6 months after the surgery. The patient received chemotherapy of 4 courses of FOLFOXIRI plus bevacizumab(Bev). A Grade 4 adverse event(febrile neutropenia)occurred but the treatment was continued after a dose reduction to 80%. The size of the tumor decreased significantly after chemotherapy and posterior pelvic exenteration with sacral resection was performed. Pathological analysis revealed a positive radial margin but there were no remarkable complications after surgery and no obvious recurrence during the 9 months after the operation. Therefore, we concluded that FOLFOXIRI plus Bev chemotherapy is a manageable and useful treatment for locally recurrent rectal cancer.
要旨
症例は60歳,女性。下部直腸癌に対し術前補助化学療法後,開腹ISR,両側側方リンパ節郭清を行った。病理結果はpT3N1M0でR0手術となった。術後6か月で直腸後腔に局所再発を認め,一期的切除も検討したが切除困難が予想されたため,FOLFOXIRI+bevacizumab(Bev)療法を4コース施行した。有害事象としてGrade 4の発熱性好中球減少を認めたが,減量にて継続可能であった。腫瘍は著明に縮小し遠隔転移を認めず,切除可能と判断し開腹後方骨盤内臓全摘仙骨合併切除術を施行した。病理結果ではR1であったが外科的に一塊に切除でき,欠損部への皮弁も必要とせず,術後も大きな合併症は認めなかった。現在術後9か月にて再発所見なく経過中である。FOLFOXIRI+Bev療法は症例を選べば有害事象も管理可能な範囲であり,奏効率も高く有用な治療選択肢と考えられた。