内容紹介
Summary
The patient was a 64-year-old man with Type 3 advanced cancer in the upper body of the stomach. The preoperative tumor marker value of CA19-9 was abnormally high, but there was no proof of distant metastasis or peritoneal dissemination. The first operation was an exploratory laparotomy due to direct tumor invasion to the pancreas. Systemic chemotherapy was performed for tumor reduction. First, S-1 plus cisplatin therapy was administered for 4 courses but discontinued because of renal dysfunction and thrombocytopenia. In the second-line therapy, ramucirumab plus paclitaxel therapy was administered for 7 courses. Since the tumor invasion to the pancreas turned to be clear based on a CT scan, total gastrectomy with regional lymphadenectomy was performed. However, 5 months after surgery, a single nodule appeared in the upper abdomen that was suspected to be peritoneal dissemination. Nivolumab therapy was administered for 16 months without tumor enlargement or any adverse effect. Recently, there has been a marked development in chemotherapy for gastric cancer. Unresectable cases became operable after the administration of appropriate chemotherapy. In our case, nivolumab therapy had no adverse effect. However, serious adverse effects have been reported by several authors which suggests that regular examinations for interstitial pneumonia, hypothyroidism, and other adverse effects are important.
要旨
症例は64歳,男性。胃癌,UM,Type 3の診断で手術を施行したが,膵浸潤により試験開腹に終わった。化学療法の一次治療としてS-1+CDDP療法を施行したが,腎機能低下と血小板減少により4コースで中止となり,二次治療としてpaclitaxel+ramucirumab療法に変更して7コースを施行した。いずれもday 15は好中球減少のために休薬となるも,CT画像で胃と膵臓との境界が明瞭化し,無事に胃全摘術を施行し得た。手術5か月後にCT画像上,単発の腹膜播種転移巣が出現したため,三次治療としてnivolumab療法を開始した。33コースを終えた現在,無増悪生存中である。胃癌においては切除不能例でも化学療法を適宜変更しながら継続することで,病勢制御が可能になることもあると考えられた。また,nivolumabに関しては極めて重篤な有害事象も報告されているため,長期投与の際は間質性肺炎や甲状腺,副腎機能などをこまめにチェックする必要があると考えられた。
目次
The patient was a 64-year-old man with Type 3 advanced cancer in the upper body of the stomach. The preoperative tumor marker value of CA19-9 was abnormally high, but there was no proof of distant metastasis or peritoneal dissemination. The first operation was an exploratory laparotomy due to direct tumor invasion to the pancreas. Systemic chemotherapy was performed for tumor reduction. First, S-1 plus cisplatin therapy was administered for 4 courses but discontinued because of renal dysfunction and thrombocytopenia. In the second-line therapy, ramucirumab plus paclitaxel therapy was administered for 7 courses. Since the tumor invasion to the pancreas turned to be clear based on a CT scan, total gastrectomy with regional lymphadenectomy was performed. However, 5 months after surgery, a single nodule appeared in the upper abdomen that was suspected to be peritoneal dissemination. Nivolumab therapy was administered for 16 months without tumor enlargement or any adverse effect. Recently, there has been a marked development in chemotherapy for gastric cancer. Unresectable cases became operable after the administration of appropriate chemotherapy. In our case, nivolumab therapy had no adverse effect. However, serious adverse effects have been reported by several authors which suggests that regular examinations for interstitial pneumonia, hypothyroidism, and other adverse effects are important.
要旨
症例は64歳,男性。胃癌,UM,Type 3の診断で手術を施行したが,膵浸潤により試験開腹に終わった。化学療法の一次治療としてS-1+CDDP療法を施行したが,腎機能低下と血小板減少により4コースで中止となり,二次治療としてpaclitaxel+ramucirumab療法に変更して7コースを施行した。いずれもday 15は好中球減少のために休薬となるも,CT画像で胃と膵臓との境界が明瞭化し,無事に胃全摘術を施行し得た。手術5か月後にCT画像上,単発の腹膜播種転移巣が出現したため,三次治療としてnivolumab療法を開始した。33コースを終えた現在,無増悪生存中である。胃癌においては切除不能例でも化学療法を適宜変更しながら継続することで,病勢制御が可能になることもあると考えられた。また,nivolumabに関しては極めて重篤な有害事象も報告されているため,長期投与の際は間質性肺炎や甲状腺,副腎機能などをこまめにチェックする必要があると考えられた。