内容紹介
Summary
A 64-year-old man was diagnosed with advanced gastric cancer based on an endoscopic examination in June 2009; histological findings indicated poorly differentiated adenocarcinoma. Computed tomography revealed multiple liver metastases and bulky lymph node metastases of LN#7. The multiple liver metastases of the gastric cancer were not considered to be candidates for surgical resection, and S-1/CDDP chemotherapy was initiated in July 2009. After 6 courses of this regimen, liver and lymph node metastases showed partial response(PR), but the gastric tumor showed progressive disease(PD). Therefore, we switched this regimen to bi-weekly CPT-11/CDDP in March 2010. However, because the gastric tumor had increased in size and presented with bleeding, we performed distal gastrectomy. The pathological diagnosis based on the resected specimen was large-cell neuroendocrine carcinoma. After surgery, CPT-11/CDDP was continued but was switched to CPT-11 in June 2011 because of induced renal dysfunction. In November 2011, the regimen was switched to weekly paclitaxel because of a progressive increase in size of a solitary liver metastatic lesion located in S4-5. Two courses of this regimen were administered, but they were ineffective; therefore, we performed partial hepatectomy. No other recurrent lesions were observed during the surgery, and the patient was estimated to have achieved complete response(CR). After the surgery, no further adjuvant chemotherapy was administered. Four years after hepatectomy, the patient was diagnosed with esophageal cancer but exhibited no recurrence of the gastric cancer. We performed esophagectomy for the esophageal cancer in May 2016. The patient is currently well without any relapse.
要旨
症例は64歳,男性。2009年6月に上部消化管内視鏡検査にて進行胃癌と診断された。生検の組織学的検査では低分化型腺癌であった。CTでは多発肝転移とLN#7のbulkyなリンパ節転移を認めた。肝転移巣は切除不能と判断したため,2009年7月よりS-1/CDDPの投与を開始した。6コース施行後,肝,リンパ節転移はPRであったが,主病巣はPDであった。2010年3月から化学療法をbi-weekly CPT-11/CDDPに変更した。しかし主病巣はさらに増大し,出血を起こしてきたため幽門側胃切除術を行った。切除標本の組織学的検査は大細胞型内分泌細胞癌であった。術後CPT-11/CDDPを再開したが,腎機能障害を認めたため2011年6月からCPT-11単独投与に変更した。その後,肝S4-5の転移巣が増大してきたため同年11月よりweekly PTXに変更した。2コース施行したが,さらに増大を認めたため肝S4-5部分切除術を施行した。術中検索ではその他の肝転移および再発は認めなかった。肝切除後は化学療法を行わずに経過観察を行っているが,現在も再発を認めていない。
目次
A 64-year-old man was diagnosed with advanced gastric cancer based on an endoscopic examination in June 2009; histological findings indicated poorly differentiated adenocarcinoma. Computed tomography revealed multiple liver metastases and bulky lymph node metastases of LN#7. The multiple liver metastases of the gastric cancer were not considered to be candidates for surgical resection, and S-1/CDDP chemotherapy was initiated in July 2009. After 6 courses of this regimen, liver and lymph node metastases showed partial response(PR), but the gastric tumor showed progressive disease(PD). Therefore, we switched this regimen to bi-weekly CPT-11/CDDP in March 2010. However, because the gastric tumor had increased in size and presented with bleeding, we performed distal gastrectomy. The pathological diagnosis based on the resected specimen was large-cell neuroendocrine carcinoma. After surgery, CPT-11/CDDP was continued but was switched to CPT-11 in June 2011 because of induced renal dysfunction. In November 2011, the regimen was switched to weekly paclitaxel because of a progressive increase in size of a solitary liver metastatic lesion located in S4-5. Two courses of this regimen were administered, but they were ineffective; therefore, we performed partial hepatectomy. No other recurrent lesions were observed during the surgery, and the patient was estimated to have achieved complete response(CR). After the surgery, no further adjuvant chemotherapy was administered. Four years after hepatectomy, the patient was diagnosed with esophageal cancer but exhibited no recurrence of the gastric cancer. We performed esophagectomy for the esophageal cancer in May 2016. The patient is currently well without any relapse.
要旨
症例は64歳,男性。2009年6月に上部消化管内視鏡検査にて進行胃癌と診断された。生検の組織学的検査では低分化型腺癌であった。CTでは多発肝転移とLN#7のbulkyなリンパ節転移を認めた。肝転移巣は切除不能と判断したため,2009年7月よりS-1/CDDPの投与を開始した。6コース施行後,肝,リンパ節転移はPRであったが,主病巣はPDであった。2010年3月から化学療法をbi-weekly CPT-11/CDDPに変更した。しかし主病巣はさらに増大し,出血を起こしてきたため幽門側胃切除術を行った。切除標本の組織学的検査は大細胞型内分泌細胞癌であった。術後CPT-11/CDDPを再開したが,腎機能障害を認めたため2011年6月からCPT-11単独投与に変更した。その後,肝S4-5の転移巣が増大してきたため同年11月よりweekly PTXに変更した。2コース施行したが,さらに増大を認めたため肝S4-5部分切除術を施行した。術中検索ではその他の肝転移および再発は認めなかった。肝切除後は化学療法を行わずに経過観察を行っているが,現在も再発を認めていない。