内容紹介
Summary
We report a case of pulmonary metastasis from hilar cholangiocarcinoma successfully treated by stereotactic body radiotherapy. The patient was a 70-year-old woman who underwent extended left hemi-hepatectomy with bile duct reconstruction for hilar cholangiocarcinoma at the age of 67. Pathological diagnosis indicated a well-differentiated adenocarcinoma. We followed up the patient without adjuvant chemotherapy. Nineteen months after the initial resection, a solitary pulmonary metastasis was detected in the right upper lobe. The patient received gemcitabine plus cisplatin(GC)therapy. After 4 courses of GC therapy, the size of the pulmonary metastasis was unchanged. Therefore, we performed a thoracoscopic wedge resection. Pathological diagnosis indicated that the pulmonary metastasis originated from the cholangiocarcinoma. Fifteen months after the pulmonary resection, another solitary pulmonary metastasis was detected in the left lower lobe. As the patient refused further chemotherapy, we performed stereotactic body radiotherapy(SBRT)(50 Gy/4 Fr). An adverse event of Grade 1 radiation pneumonitis was observed. The metastasis disappeared after SBRT. Twenty-eight months after SBRT and 70 months after the initial surgery, the patient is alive without recurrence.
要旨
症例は70歳,女性。67歳時に肝門部胆管癌に対し肝拡大左葉切除,肝外胆管切除,胆道再建を施行した。術後病理組織学的診断はpT2bN0M0,pStageⅡであった。術後補助化学療法は行わず経過観察中であったが,術後1年7か月,右肺上葉に孤立性肺転移が出現した。gemcitabine+cisplatin(GC)療法を4コース施行後,肺転移の増大なく,胸腔鏡下右肺上葉部分切除術を施行した。病理組織学的診断は肝門部胆管癌肺転移であった。以後経過観察中であったが,右肺転移巣切除術後1年3か月,左肺下葉に孤立性肺転移が出現した。化学療法を希望されなかったため,体幹部定位放射線治療(SBRT)(50 Gy/4 Fr)を施行した。転移巣は消失し,有害事象は放射性肺臓炎Grade 1のみであった。原発巣術後5年10か月(SBRT施行後2年4か月)現在,無再発生存中である。
目次
We report a case of pulmonary metastasis from hilar cholangiocarcinoma successfully treated by stereotactic body radiotherapy. The patient was a 70-year-old woman who underwent extended left hemi-hepatectomy with bile duct reconstruction for hilar cholangiocarcinoma at the age of 67. Pathological diagnosis indicated a well-differentiated adenocarcinoma. We followed up the patient without adjuvant chemotherapy. Nineteen months after the initial resection, a solitary pulmonary metastasis was detected in the right upper lobe. The patient received gemcitabine plus cisplatin(GC)therapy. After 4 courses of GC therapy, the size of the pulmonary metastasis was unchanged. Therefore, we performed a thoracoscopic wedge resection. Pathological diagnosis indicated that the pulmonary metastasis originated from the cholangiocarcinoma. Fifteen months after the pulmonary resection, another solitary pulmonary metastasis was detected in the left lower lobe. As the patient refused further chemotherapy, we performed stereotactic body radiotherapy(SBRT)(50 Gy/4 Fr). An adverse event of Grade 1 radiation pneumonitis was observed. The metastasis disappeared after SBRT. Twenty-eight months after SBRT and 70 months after the initial surgery, the patient is alive without recurrence.
要旨
症例は70歳,女性。67歳時に肝門部胆管癌に対し肝拡大左葉切除,肝外胆管切除,胆道再建を施行した。術後病理組織学的診断はpT2bN0M0,pStageⅡであった。術後補助化学療法は行わず経過観察中であったが,術後1年7か月,右肺上葉に孤立性肺転移が出現した。gemcitabine+cisplatin(GC)療法を4コース施行後,肺転移の増大なく,胸腔鏡下右肺上葉部分切除術を施行した。病理組織学的診断は肝門部胆管癌肺転移であった。以後経過観察中であったが,右肺転移巣切除術後1年3か月,左肺下葉に孤立性肺転移が出現した。化学療法を希望されなかったため,体幹部定位放射線治療(SBRT)(50 Gy/4 Fr)を施行した。転移巣は消失し,有害事象は放射性肺臓炎Grade 1のみであった。原発巣術後5年10か月(SBRT施行後2年4か月)現在,無再発生存中である。