内容紹介
Summary
Pancreatic ductal carcinoma is one of the leading causes of cancer deaths in Japan. However, with remarkable progress in chemotherapy, studies have reported successful resection of initially unresectable pancreatic adenocarcinoma after chemotherapy. We report a case of curative surgery of pancreatic ductal adenocarcinoma with liver metastasis after chemotherapy. A 66-year-old man presenting with jaundice and weight loss was admitted to our hospital for an evaluation of pancreatic lesions. Computed tomography revealed a hypoattenuating mass in the head of the pancreas. We diagnosed this cancer as cT4(SMA>1/2)N1M0, cStage Ⅲ and performed chemoradiotherapy for this locally advanced pancreatic cancer. Because of the appearance of liver metastasis, we treated this patient with GEM plus nab-PTX chemotherapy. There were no serious adverse events. After 3 therapy courses, the existing liver metastasis disappeared, and no new metastases were noted. Therefore, radical subtotal stomach-preserving pancreatoduodenectomy was performed. The tumor was diagnosed as moderately differentiated adenocarcinoma, ypT1a ypN0 ypM0, ypStageⅠA, R0.
要旨
FOLFIRINOX療法やゲムシタビン塩酸塩(GEM)+nab-パクリタキセル(PTX)併用療法が切除不能進行膵癌に対して高い有用性を示してきている。 化学療法後に根治切除し得た肝転移を伴う切除不能膵癌の1例を経験したため報告する。症例は66歳,男性。黄疸を主訴に受診し,膵頭部癌による閉塞性黄疸と診断した。SMAの半周を越えて腫瘍が接していたため,切除不能膵癌との診断で化学放射線治療(GEM+S-1+RT)を施行した。治療評価にて肝S8に新規病変が出現したため,GEM+nab-PTXを3コース施行したところ,画像上肝転移が消失,原発巣の縮小(SMAと接している範囲が半周未満)を認めた。審査腹腔鏡で根治切除可能と判断したため,1か月後膵頭十二指腸切除術を施行し経過は良好で術後22日目に退院となった。病理診断はypT1a,ypN0,ypM0,ypStageⅠA,R0であり,治療効果判定はEvans分類Grade Ⅲであった。
目次
Pancreatic ductal carcinoma is one of the leading causes of cancer deaths in Japan. However, with remarkable progress in chemotherapy, studies have reported successful resection of initially unresectable pancreatic adenocarcinoma after chemotherapy. We report a case of curative surgery of pancreatic ductal adenocarcinoma with liver metastasis after chemotherapy. A 66-year-old man presenting with jaundice and weight loss was admitted to our hospital for an evaluation of pancreatic lesions. Computed tomography revealed a hypoattenuating mass in the head of the pancreas. We diagnosed this cancer as cT4(SMA>1/2)N1M0, cStage Ⅲ and performed chemoradiotherapy for this locally advanced pancreatic cancer. Because of the appearance of liver metastasis, we treated this patient with GEM plus nab-PTX chemotherapy. There were no serious adverse events. After 3 therapy courses, the existing liver metastasis disappeared, and no new metastases were noted. Therefore, radical subtotal stomach-preserving pancreatoduodenectomy was performed. The tumor was diagnosed as moderately differentiated adenocarcinoma, ypT1a ypN0 ypM0, ypStageⅠA, R0.
要旨
FOLFIRINOX療法やゲムシタビン塩酸塩(GEM)+nab-パクリタキセル(PTX)併用療法が切除不能進行膵癌に対して高い有用性を示してきている。 化学療法後に根治切除し得た肝転移を伴う切除不能膵癌の1例を経験したため報告する。症例は66歳,男性。黄疸を主訴に受診し,膵頭部癌による閉塞性黄疸と診断した。SMAの半周を越えて腫瘍が接していたため,切除不能膵癌との診断で化学放射線治療(GEM+S-1+RT)を施行した。治療評価にて肝S8に新規病変が出現したため,GEM+nab-PTXを3コース施行したところ,画像上肝転移が消失,原発巣の縮小(SMAと接している範囲が半周未満)を認めた。審査腹腔鏡で根治切除可能と判断したため,1か月後膵頭十二指腸切除術を施行し経過は良好で術後22日目に退院となった。病理診断はypT1a,ypN0,ypM0,ypStageⅠA,R0であり,治療効果判定はEvans分類Grade Ⅲであった。