内容紹介
Summary
The patient was a 65-year-old man. His complaints included bloody stools and pain on urination. A detailed examination suggested vesical wall invasion, leading to a diagnosis of rectosigmoid cancer(cT4b, N+, M0). For R0 surgery, total cystectomy was considered necessary. To maintain vesical function, tumor-reducing chemotherapy was selected. After colostomy for the sigmoid colon, 4 courses of mFOLFOX6 plus bevacizumab therapy were administered. There was a marked reduction in the tumor size; therefore, 3 courses of mFOLFOX6 plus panitumumab therapy were administered as preoperative chemotherapy before resection. Partial response(PR)was achieved, and there was no urinary bladder infiltration. Therefore, surgery was performed. There was no tumor invasion to any other organ. High anterior rectal resection was performed. The pathological diagnosis also confirmed the efficacy of chemotherapy. We report about a patient in whom extended surgery could be avoided by administering chemotherapy for advanced rectosigmoid cancer with urinary bladder invasion.
要旨
症例は65歳,男性。主訴は血便と排尿時痛。精査にて膀胱壁への浸潤を疑わせる直腸S状部癌,cT4b,N1以上M0と診断した。根治度A手術のためには膀胱全摘となる可能性があると判断し,膀胱機能温存のため腫瘍縮小をめざした化学療法を行う方針とした。S状結腸に双孔式人工肛門を造設後,mFOLFOX6+bevacizumab療法を4コース施行した。さらなる効果を期待し,切除を目的とした術前化学療法としてmFOLFOX6+panitumumab療法を3コース行った。2か月後の効果判定にてPRと判定し手術を行った。腫瘍は他臓器への浸潤を認めず,直腸高位前方切除術を施行,病理診断でも化学療法の効果が認められた。膀胱浸潤を伴う進行直腸S状部癌に対し化学療法を行い,拡大手術を回避できた症例を経験したので報告する。
目次
The patient was a 65-year-old man. His complaints included bloody stools and pain on urination. A detailed examination suggested vesical wall invasion, leading to a diagnosis of rectosigmoid cancer(cT4b, N+, M0). For R0 surgery, total cystectomy was considered necessary. To maintain vesical function, tumor-reducing chemotherapy was selected. After colostomy for the sigmoid colon, 4 courses of mFOLFOX6 plus bevacizumab therapy were administered. There was a marked reduction in the tumor size; therefore, 3 courses of mFOLFOX6 plus panitumumab therapy were administered as preoperative chemotherapy before resection. Partial response(PR)was achieved, and there was no urinary bladder infiltration. Therefore, surgery was performed. There was no tumor invasion to any other organ. High anterior rectal resection was performed. The pathological diagnosis also confirmed the efficacy of chemotherapy. We report about a patient in whom extended surgery could be avoided by administering chemotherapy for advanced rectosigmoid cancer with urinary bladder invasion.
要旨
症例は65歳,男性。主訴は血便と排尿時痛。精査にて膀胱壁への浸潤を疑わせる直腸S状部癌,cT4b,N1以上M0と診断した。根治度A手術のためには膀胱全摘となる可能性があると判断し,膀胱機能温存のため腫瘍縮小をめざした化学療法を行う方針とした。S状結腸に双孔式人工肛門を造設後,mFOLFOX6+bevacizumab療法を4コース施行した。さらなる効果を期待し,切除を目的とした術前化学療法としてmFOLFOX6+panitumumab療法を3コース行った。2か月後の効果判定にてPRと判定し手術を行った。腫瘍は他臓器への浸潤を認めず,直腸高位前方切除術を施行,病理診断でも化学療法の効果が認められた。膀胱浸潤を伴う進行直腸S状部癌に対し化学療法を行い,拡大手術を回避できた症例を経験したので報告する。