内容紹介
Summary
As a part of community screening, a 64-year-old man underwent gastric fluoroscopy, which revealed abnormalities indicative of a type 3 tumor. Contrast-enhanced abdominal computed tomography showed advanced gastric cancer with multiple regional lymph nodes and liver metastases. Chemotherapy was initiated, and after completion of 2 courses of capecitabine(Cape)and oxaliplatin(OHP)therapy, a distal gastrectomy was performed. The response to chemotherapy was Grade 2, and the lymph node status was pN1(1/17). The patient was strongly positive for HER2; thus, 4 courses of Cape, OHP, and trastuzumab(T-mab)therapy were administered for the metastatic liver lesions, and the liver metastases shrank markedly. S5 subsegmentectomy and S7 partial resection were performed subsequently, and pathological analysis showed completely necrotic tissue. Remarkable progress has been made in chemotherapy for gastric cancer, and the use of T-mab in combination is extremely effective for gastric cancer that is strongly positive for HER2. In our patient, we resected the primary lesion and liver metastatic lesions after neoadjuvant chemotherapy. The metastatic lesion showed complete response(CR). Metastases and recurrences can even occur in patients with primary and/or metastatic lesions who show a CR. Furthermore, whether cancers that are strongly positive for HER2 are recurrent remains unknown. The patient is alive and recurrence-free after having undergone a hepatectomy.
要旨
症例は64歳,男性。住民検診の上部消化管造影検査で3型腫瘍を指摘された。領域リンパ節転移および多発肝転移を伴う進行胃癌の診断で化学療法の適応と判断し,Cape/OHP療法を2コース終了後,幽門側胃切除術を施行した。化学療法の組織学的効果判定はGrade 2であった。HER2強陽性が判明後,T-mab/Cape/OHP療法を4コース施行し肝転移巣が著明に縮小したため,肝S5亜区域・S7部分切除を施行した。病理組織学的結果は完全壊死組織で,化学療法の組織学的効果判定はGrade 3であった。胃癌に対する化学療法は著しく進歩し,T-mabの併用はHER2強陽性胃癌に対して極めて効果的であった。
目次
As a part of community screening, a 64-year-old man underwent gastric fluoroscopy, which revealed abnormalities indicative of a type 3 tumor. Contrast-enhanced abdominal computed tomography showed advanced gastric cancer with multiple regional lymph nodes and liver metastases. Chemotherapy was initiated, and after completion of 2 courses of capecitabine(Cape)and oxaliplatin(OHP)therapy, a distal gastrectomy was performed. The response to chemotherapy was Grade 2, and the lymph node status was pN1(1/17). The patient was strongly positive for HER2; thus, 4 courses of Cape, OHP, and trastuzumab(T-mab)therapy were administered for the metastatic liver lesions, and the liver metastases shrank markedly. S5 subsegmentectomy and S7 partial resection were performed subsequently, and pathological analysis showed completely necrotic tissue. Remarkable progress has been made in chemotherapy for gastric cancer, and the use of T-mab in combination is extremely effective for gastric cancer that is strongly positive for HER2. In our patient, we resected the primary lesion and liver metastatic lesions after neoadjuvant chemotherapy. The metastatic lesion showed complete response(CR). Metastases and recurrences can even occur in patients with primary and/or metastatic lesions who show a CR. Furthermore, whether cancers that are strongly positive for HER2 are recurrent remains unknown. The patient is alive and recurrence-free after having undergone a hepatectomy.
要旨
症例は64歳,男性。住民検診の上部消化管造影検査で3型腫瘍を指摘された。領域リンパ節転移および多発肝転移を伴う進行胃癌の診断で化学療法の適応と判断し,Cape/OHP療法を2コース終了後,幽門側胃切除術を施行した。化学療法の組織学的効果判定はGrade 2であった。HER2強陽性が判明後,T-mab/Cape/OHP療法を4コース施行し肝転移巣が著明に縮小したため,肝S5亜区域・S7部分切除を施行した。病理組織学的結果は完全壊死組織で,化学療法の組織学的効果判定はGrade 3であった。胃癌に対する化学療法は著しく進歩し,T-mabの併用はHER2強陽性胃癌に対して極めて効果的であった。