内容紹介
Summary
An 82-year-old woman presented with a dull feeling in her stomach and anemia. The gastroscopy and abdominal CT scan showed a progressive gastric tumor with multiple liver metastases, and a biopsy specimen revealed moderately differentiated tubular adenocarcinoma. A subtotal gastrectomy with D1 plus lymph node dissection was performed. The final diagnosis was as follows: H1, P0, CY0, M1, pT3, pN2, and fStageⅣ. We considered her age, and postoperative chemotherapy with of an oral anticancer drug, S-1, was initiated at a daily dose of 100 mg, with a 2-week administration and 1-week suspension schedule. The multiple liver metastases obviously reduced in size(PR)by 3 months, and the CT scan revealed complete response(CR)by 8 months after beginning S-1 administration. However, grade 2 anorexia and general malaise developed, so the S-1 administration was changed to a daily dose of 80 mg, with a 2-week administration and 2-week suspension schedule. However, an adverse event of nausea appeared again, and the patient needed a 2-month discontinuation. Therefore, S-1 administration was changed to alternate-day administration, at a daily dose of 100 mg. Subsequently, no side effects were observed, and we continued the S-1 administration for 4 years. She has maintained a complete response(CR)for 10 years, with no obvious cancer recurrence.
要旨
症例は82歳,女性。胃もたれと貧血を主訴に当院を受診した。上部消化管内視鏡検査で胃前庭部大弯中心の2型腫瘍を認め,生検で中分化型管状腺癌と診断した。腹部造影CT検査では多発肝転移を認めた。原発巣切除目的で幽門側胃切除術[pT3N2M1(HEP),pStageⅣ]を施行し,術後は年齢とADLを考慮してS-1単独療法(100 mg/日,2週投与1週休薬)を開始した。3か月で多発肝転移は縮小し8か月後には画像上CRを得たが,食欲不振,全身倦怠感のため一時休薬した。その後80 mg/日に減量し2週投与2週休薬法に変更したが,再び有害事象のため内服継続困難となった。2か月間の休薬後に隔日投与法(100 mg/日,週4回)に変更したところ副作用の出現なく経過し,約4年間内服を継続した。術後10年以上経過し再発兆候は認めていない。S-1内服のみで多発肝転移が消失し長期生存を得た1例を経験したので報告する。
目次
An 82-year-old woman presented with a dull feeling in her stomach and anemia. The gastroscopy and abdominal CT scan showed a progressive gastric tumor with multiple liver metastases, and a biopsy specimen revealed moderately differentiated tubular adenocarcinoma. A subtotal gastrectomy with D1 plus lymph node dissection was performed. The final diagnosis was as follows: H1, P0, CY0, M1, pT3, pN2, and fStageⅣ. We considered her age, and postoperative chemotherapy with of an oral anticancer drug, S-1, was initiated at a daily dose of 100 mg, with a 2-week administration and 1-week suspension schedule. The multiple liver metastases obviously reduced in size(PR)by 3 months, and the CT scan revealed complete response(CR)by 8 months after beginning S-1 administration. However, grade 2 anorexia and general malaise developed, so the S-1 administration was changed to a daily dose of 80 mg, with a 2-week administration and 2-week suspension schedule. However, an adverse event of nausea appeared again, and the patient needed a 2-month discontinuation. Therefore, S-1 administration was changed to alternate-day administration, at a daily dose of 100 mg. Subsequently, no side effects were observed, and we continued the S-1 administration for 4 years. She has maintained a complete response(CR)for 10 years, with no obvious cancer recurrence.
要旨
症例は82歳,女性。胃もたれと貧血を主訴に当院を受診した。上部消化管内視鏡検査で胃前庭部大弯中心の2型腫瘍を認め,生検で中分化型管状腺癌と診断した。腹部造影CT検査では多発肝転移を認めた。原発巣切除目的で幽門側胃切除術[pT3N2M1(HEP),pStageⅣ]を施行し,術後は年齢とADLを考慮してS-1単独療法(100 mg/日,2週投与1週休薬)を開始した。3か月で多発肝転移は縮小し8か月後には画像上CRを得たが,食欲不振,全身倦怠感のため一時休薬した。その後80 mg/日に減量し2週投与2週休薬法に変更したが,再び有害事象のため内服継続困難となった。2か月間の休薬後に隔日投与法(100 mg/日,週4回)に変更したところ副作用の出現なく経過し,約4年間内服を継続した。術後10年以上経過し再発兆候は認めていない。S-1内服のみで多発肝転移が消失し長期生存を得た1例を経験したので報告する。