内容紹介
Summary
An 85-year-old man was diagnosed with esophagogastric junctional adenocarcinoma, E=G, Type 2, por, 6 cm in size, cT4aN1M0, cStage ⅢA. He had a history of atherosclerosis obliterans and thoracoabdominal aortic aneurysm. Considering the comorbidities and life expectancy, we decided to perform chemotherapy without tumor resection. Although the renal function was poor, we chose SP therapy(S-1 80 mg/kg/day for 14 days, followed by 7-day rest, CDDP 30 mg/kg/day on day 1)because the current status of the patient was satisfactory. The primary tumor remarkably shrank after 2 courses of SP therapy and completely disappeared after 5 courses of SP therapy. There were no adverse events during the entire course of treatment. We detected clinical CR and provided the S-1 monotherapy for another 2 years. The patient has survived with no recurrences for 7 years since the initial chemotherapy. Although intensive chemotherapy regimens are avoided in elderly patients, the patient, in this case, showed a favorable prognosis from powerful chemotherapy.
要旨
症例は85歳,男性。食道胃接合部癌,G=E,Type 2,por,長径6 cm,cT4aN1M0,cStage ⅢAの診断で手術を検討した。しかし既往に閉塞性動脈硬化症と胸腹部大動脈瘤があり,手術リスクと生命予後を考慮し,根治手術ではなく化学療法を行う方針とした。低腎機能を認めたが,全身状態は良好であるため標準治療であるSP療法(S-1/CDDP 2週投与1週休薬)を選択した。有害事象なく2コース終了した時点で腫瘍は著明に縮小し,5コース終了した時点で腫瘍は消失し臨床的CRが得られた。その後S-1単独療法を2年間継続し,治療開始後から現在に至る7年間無再発を維持している。高齢者への化学療法は敬遠される傾向にあるが,本症例では手術を回避し強度な化学療法を選択したことでQOLを維持しつつ良好な予後が得られた。
目次
An 85-year-old man was diagnosed with esophagogastric junctional adenocarcinoma, E=G, Type 2, por, 6 cm in size, cT4aN1M0, cStage ⅢA. He had a history of atherosclerosis obliterans and thoracoabdominal aortic aneurysm. Considering the comorbidities and life expectancy, we decided to perform chemotherapy without tumor resection. Although the renal function was poor, we chose SP therapy(S-1 80 mg/kg/day for 14 days, followed by 7-day rest, CDDP 30 mg/kg/day on day 1)because the current status of the patient was satisfactory. The primary tumor remarkably shrank after 2 courses of SP therapy and completely disappeared after 5 courses of SP therapy. There were no adverse events during the entire course of treatment. We detected clinical CR and provided the S-1 monotherapy for another 2 years. The patient has survived with no recurrences for 7 years since the initial chemotherapy. Although intensive chemotherapy regimens are avoided in elderly patients, the patient, in this case, showed a favorable prognosis from powerful chemotherapy.
要旨
症例は85歳,男性。食道胃接合部癌,G=E,Type 2,por,長径6 cm,cT4aN1M0,cStage ⅢAの診断で手術を検討した。しかし既往に閉塞性動脈硬化症と胸腹部大動脈瘤があり,手術リスクと生命予後を考慮し,根治手術ではなく化学療法を行う方針とした。低腎機能を認めたが,全身状態は良好であるため標準治療であるSP療法(S-1/CDDP 2週投与1週休薬)を選択した。有害事象なく2コース終了した時点で腫瘍は著明に縮小し,5コース終了した時点で腫瘍は消失し臨床的CRが得られた。その後S-1単独療法を2年間継続し,治療開始後から現在に至る7年間無再発を維持している。高齢者への化学療法は敬遠される傾向にあるが,本症例では手術を回避し強度な化学療法を選択したことでQOLを維持しつつ良好な予後が得られた。