内容紹介
Summary
A 65-year-old woman was diagnosed with simultaneous hepatic metastasis of rectal cancer with portal venous tumor thrombi(Vp3)that developed in the bifurcation of the portal vein. Four days from the first visit, abdominal dynamic contrast-enhanced CT image on the portal venous phase shows that the tumor thrombi progressed in the main trunk of the portal vein(Vp4). We decided that it was a condition of oncologic emergency and initiated FOLFOXIRI plus BV therapy. After 12 courses, tumor shrinkage and regression of the portal venous tumor thrombi were achieved, but conversion surgery was impossible because the collateral circulation of the hepatic portal region remained. The treatment target was changed to the extension of the survival period. The initiation and reinitiation of FOLFOXIRI plus BV therapy and maintenance of 5-FU/l-LV plus BV therapy contributed to disease control in 24 months and survival period of 36 months.
要旨
症例は65歳,女性。直腸癌,肝右葉の同時性肝転移が門脈侵潤し,腫瘍栓が門脈左右分岐部まで(Vp3)連続進展していた。腫瘍栓は急速に伸長し,受診から4日後のCTでは先進部が本幹に達した(Vp4)。oncologic emergencyの病態と判断してFOLFOXIRI+BVを導入した。12コース施行後,腫瘍縮小と腫瘍栓の退縮効果は得られたが,肝門部の側副血行路が遺残したためconversion手術は不能と判断した。治療目標を生存期間の延長に変更し,FOLFOXIRI+BVと5-FU/l-LV+BVによる導入・維持・再導入により24か月の病勢コントロール,36か月の生存期間延長が得られている。
目次
A 65-year-old woman was diagnosed with simultaneous hepatic metastasis of rectal cancer with portal venous tumor thrombi(Vp3)that developed in the bifurcation of the portal vein. Four days from the first visit, abdominal dynamic contrast-enhanced CT image on the portal venous phase shows that the tumor thrombi progressed in the main trunk of the portal vein(Vp4). We decided that it was a condition of oncologic emergency and initiated FOLFOXIRI plus BV therapy. After 12 courses, tumor shrinkage and regression of the portal venous tumor thrombi were achieved, but conversion surgery was impossible because the collateral circulation of the hepatic portal region remained. The treatment target was changed to the extension of the survival period. The initiation and reinitiation of FOLFOXIRI plus BV therapy and maintenance of 5-FU/l-LV plus BV therapy contributed to disease control in 24 months and survival period of 36 months.
要旨
症例は65歳,女性。直腸癌,肝右葉の同時性肝転移が門脈侵潤し,腫瘍栓が門脈左右分岐部まで(Vp3)連続進展していた。腫瘍栓は急速に伸長し,受診から4日後のCTでは先進部が本幹に達した(Vp4)。oncologic emergencyの病態と判断してFOLFOXIRI+BVを導入した。12コース施行後,腫瘍縮小と腫瘍栓の退縮効果は得られたが,肝門部の側副血行路が遺残したためconversion手術は不能と判断した。治療目標を生存期間の延長に変更し,FOLFOXIRI+BVと5-FU/l-LV+BVによる導入・維持・再導入により24か月の病勢コントロール,36か月の生存期間延長が得られている。