内容紹介
Summary
Case 1: A 59-year-old man was diagnosed with type 3 gastric cancer cStage Ⅲ(MU, Gre, tub2>por, cT4aN2M0)induced by gastric perforation. The first surgery involving resection of the lesser curvature of stomach lymph node was judged to be difficult, and eventually exploratory laparotomy was performed. He received 3 courses of chemotherapy using S-1 plus oxaliplatin(SOX)(S-1 120 mg/m2/day, day 1-14, oxaliplatin 100 mg/m2, day 1, followed by 7 days of rest). He subsequently underwent curative laparotomy gastrectomy plus D2(-No. 10)lymph node dissection, and Roux-en-Y reconstruction. Histological type was judged to be Grade 3. Case 2: A 69-year-old man was diagnosed with type 2 esophageal gastric junctional cancer,(GE, Less, tub2, cT4aN3M1[LYM])of cStage Ⅳ. He received 6 courses of chemotherapy using trastuzumab plus S-1 plus oxaliplatin(HER plus SOX)(trastuzumab 8 mg/kg[2nd course 6 mg/kg], day 1, S-1 120 mg/m2/day, day 1-14, oxaliplatin 100 mg/m2[5th course 80 mg/m2], on day 1, followed by 7 days of rest). He subsequently underwent laparotomy of the lower esophageal total gastrectomy plus D2(-No. 10, +No. 16, No. 110)lymph node dissection, and Roux-en-Y reconstruction as conversion surgery. Histological type was Grade 3. Both were impressive cases suggesting the usefulness of SOX therapy as a multidisciplinary treatment strategy for advanced gastric cancer.
要旨
症例1は59歳,男性。胃穿孔を契機に胃癌,MU,Gre,type 3,tub2>por,cT4aN2M0,cStage Ⅲと診断された。初回手術は小弯側リンパ節が切除困難と判断し,試験開腹に終わった。SOX療法[S-1 120 mg/m2/day,14日間,oxaliplatin 100 mg/m2,day 1,7日間休薬]を3コース施行後にPRが得られ,開腹胃全摘+D2(-No. 10)リンパ節郭清,Roux-en-Y再建を施行した。組織学的効果判定はGrade 3であった。症例2は69歳,男性。食道胃接合部癌,GE,Less,type 2,tub2,cT4aN3M1(LYM),cStage Ⅳと診断した。HER+SOX療法を[trastuzumab 8 mg/kg(2回目以降6 mg/kg),day 1,S-1 120 mg/m2/day,14日間,oxaliplatin 100 mg/m2(5回目以降80 mg/m2),day 1,7日間休薬]を6コース施行後にPRが得られ,conversion surgeryとして開腹下部食道胃全摘+D2(-No. 10,+No. 16,No. 110)リンパ節郭清,Roux-en-Y再建を施行した。組織学的効果判定はGrade 3であった。2症例とも進行胃癌に対する集学的治療戦略としてのSOX療法の有用性が示唆される印象深い症例であった。
目次
Case 1: A 59-year-old man was diagnosed with type 3 gastric cancer cStage Ⅲ(MU, Gre, tub2>por, cT4aN2M0)induced by gastric perforation. The first surgery involving resection of the lesser curvature of stomach lymph node was judged to be difficult, and eventually exploratory laparotomy was performed. He received 3 courses of chemotherapy using S-1 plus oxaliplatin(SOX)(S-1 120 mg/m2/day, day 1-14, oxaliplatin 100 mg/m2, day 1, followed by 7 days of rest). He subsequently underwent curative laparotomy gastrectomy plus D2(-No. 10)lymph node dissection, and Roux-en-Y reconstruction. Histological type was judged to be Grade 3. Case 2: A 69-year-old man was diagnosed with type 2 esophageal gastric junctional cancer,(GE, Less, tub2, cT4aN3M1[LYM])of cStage Ⅳ. He received 6 courses of chemotherapy using trastuzumab plus S-1 plus oxaliplatin(HER plus SOX)(trastuzumab 8 mg/kg[2nd course 6 mg/kg], day 1, S-1 120 mg/m2/day, day 1-14, oxaliplatin 100 mg/m2[5th course 80 mg/m2], on day 1, followed by 7 days of rest). He subsequently underwent laparotomy of the lower esophageal total gastrectomy plus D2(-No. 10, +No. 16, No. 110)lymph node dissection, and Roux-en-Y reconstruction as conversion surgery. Histological type was Grade 3. Both were impressive cases suggesting the usefulness of SOX therapy as a multidisciplinary treatment strategy for advanced gastric cancer.
要旨
症例1は59歳,男性。胃穿孔を契機に胃癌,MU,Gre,type 3,tub2>por,cT4aN2M0,cStage Ⅲと診断された。初回手術は小弯側リンパ節が切除困難と判断し,試験開腹に終わった。SOX療法[S-1 120 mg/m2/day,14日間,oxaliplatin 100 mg/m2,day 1,7日間休薬]を3コース施行後にPRが得られ,開腹胃全摘+D2(-No. 10)リンパ節郭清,Roux-en-Y再建を施行した。組織学的効果判定はGrade 3であった。症例2は69歳,男性。食道胃接合部癌,GE,Less,type 2,tub2,cT4aN3M1(LYM),cStage Ⅳと診断した。HER+SOX療法を[trastuzumab 8 mg/kg(2回目以降6 mg/kg),day 1,S-1 120 mg/m2/day,14日間,oxaliplatin 100 mg/m2(5回目以降80 mg/m2),day 1,7日間休薬]を6コース施行後にPRが得られ,conversion surgeryとして開腹下部食道胃全摘+D2(-No. 10,+No. 16,No. 110)リンパ節郭清,Roux-en-Y再建を施行した。組織学的効果判定はGrade 3であった。2症例とも進行胃癌に対する集学的治療戦略としてのSOX療法の有用性が示唆される印象深い症例であった。