内容紹介
Summary
A 64-year-old man was referred to our hospital to determine the cause of fecal occult blood. Colonoscopy revealed a type Ⅱ tumor located in the ascending colon. Histopathologic analysis of the tumor biopsy specimen revealed moderately differentiated, tubular adenocarcinoma with KRAS exon 2(G12V)mutation. FDG-PET/CT revealed high trace accumulation in the S4 of the liver and in multiple sites spread across the abdominal cavity(cT4aN1M1c2[H1, P3], cStage Ⅳc). Chemotherapy using S-1 plus oxaliplatin(SOX)with bevacizumab(Bmab)was administered. After 8 courses of SOX with Bmab, the volume of the ascending colon cancer and liver metastasis reduced, and peritoneal disseminations disappeared. We, therefore, considered that curability B resection was suitable, and performed right hemicolectomy, total omentectomy, and resection of the rectovesical peritoneum. Histopathological examination of surgical specimens revealed extensive fibrosis from the submucosa to subserosal tissue with some tubular adenocarcinoma cells(histological effect: Grade 2). For maintenance therapy, trifluridine/tipiracil plus Bmab was administered after cytoreduction. The patient is in remission for 26 months without recurrence. Perioperative chemotherapy and cytoreductive surgery are useful for the treatment of colon cancer with diffuse peritoneal dissemination.
要旨
症例は64歳,男性。便潜血陽性に対し下部消化管内視鏡検査を行ったところ上行結腸に全周性腫瘍を認め,生検の結果はtub2,KRAS exon 2(G12V)の変異が認められた。胸腹部CTとFDG-PET/CTの結果,cT4aN1M1c2(H1,P3),cStage Ⅳcと診断した。S-1+oxaliplatin+bevacizumab併用療法を(8 courses)施行後,腹膜播種切除(大網切除およびダグラス窩腹膜切除)を伴う結腸右半切除を施行した。薬物療法の組織学的効果判定はGrade 2であった。術後は外来でtrifluridine/tipiracil+bevacizumab併用療法を施行した。治療開始後26か月経過したが,再発の徴候を認めていない。P3大腸癌の予後は極めて不良であるが,周術期化学療法と腹膜播種切除を伴う原発巣切除は有効で妥当な治療法と考えられる。
目次
A 64-year-old man was referred to our hospital to determine the cause of fecal occult blood. Colonoscopy revealed a type Ⅱ tumor located in the ascending colon. Histopathologic analysis of the tumor biopsy specimen revealed moderately differentiated, tubular adenocarcinoma with KRAS exon 2(G12V)mutation. FDG-PET/CT revealed high trace accumulation in the S4 of the liver and in multiple sites spread across the abdominal cavity(cT4aN1M1c2[H1, P3], cStage Ⅳc). Chemotherapy using S-1 plus oxaliplatin(SOX)with bevacizumab(Bmab)was administered. After 8 courses of SOX with Bmab, the volume of the ascending colon cancer and liver metastasis reduced, and peritoneal disseminations disappeared. We, therefore, considered that curability B resection was suitable, and performed right hemicolectomy, total omentectomy, and resection of the rectovesical peritoneum. Histopathological examination of surgical specimens revealed extensive fibrosis from the submucosa to subserosal tissue with some tubular adenocarcinoma cells(histological effect: Grade 2). For maintenance therapy, trifluridine/tipiracil plus Bmab was administered after cytoreduction. The patient is in remission for 26 months without recurrence. Perioperative chemotherapy and cytoreductive surgery are useful for the treatment of colon cancer with diffuse peritoneal dissemination.
要旨
症例は64歳,男性。便潜血陽性に対し下部消化管内視鏡検査を行ったところ上行結腸に全周性腫瘍を認め,生検の結果はtub2,KRAS exon 2(G12V)の変異が認められた。胸腹部CTとFDG-PET/CTの結果,cT4aN1M1c2(H1,P3),cStage Ⅳcと診断した。S-1+oxaliplatin+bevacizumab併用療法を(8 courses)施行後,腹膜播種切除(大網切除およびダグラス窩腹膜切除)を伴う結腸右半切除を施行した。薬物療法の組織学的効果判定はGrade 2であった。術後は外来でtrifluridine/tipiracil+bevacizumab併用療法を施行した。治療開始後26か月経過したが,再発の徴候を認めていない。P3大腸癌の予後は極めて不良であるが,周術期化学療法と腹膜播種切除を伴う原発巣切除は有効で妥当な治療法と考えられる。