内容紹介
Summary
A 43-year-old man underwent a low anterior resection of the rectum due to upper rectal cancer. The pathological Stage was Ⅳ with para-aortic lymph node metastasis. Postoperative chemotherapy with CapeOX was initiated, but para-aortic lymph node metastasis was discovered 4 months after the surgery. Chemoradiation therapy with Cape and Bev, and 70 Gy/28 Fr led to the disappearance of the metastasized lesions. At 13 months after the surgery, FDG accumulation was observed in the Virchow's lymph node, and chemotherapy with IRIS and Bev was initially administered. Subsequently, chemoradiation therapy with S-1 and Bev, and 66 Gy/33 Fr was administered, followed by chemotherapy with S-1 and Bev, S-1. These therapies led to complete response(CR). However, 35 months after the surgery, the Virchow's lymph node had enlarged again, and chemoradiation therapy with S-1 and 60 Gy/30 Fr was administered. Although no FDG accumulation was detected in the lymph node at 40 months after the surgery, metastasis was found in the mediastinal lymph nodes. Panitumumab therapy achieved CR, and no metastasis had been identified at 60 months after the final therapy. Chemoradiation therapy is a treatment option to improve the prognosis of patients with metastasis only in the Virchow's lymph node.
要旨
症例は43歳,男性。傍大動脈リンパ節転移を伴うStage Ⅳの上部直腸癌に対して直腸低位前方切除術,両側側方リンパ節郭清術,傍大動脈リンパ節サンプリング術を施行した。術後補助化学療法(CapeOX)を施行するも,術後4か月で傍大動脈リンパ節転移を認め,化学放射線療法(Cape+Bev,70 Gy/28 Fr)を施行した。FDGの集積は消失したが,術後13か月でVirchowリンパ節に転移を認めIRIS+Bevを投与した後,化学放射線療法(S-1+Bev,66 Gy/33 Fr),化学療法(S-1+Bev,S-1)を施行し完全奏効を得た。しかし術後35か月にVirchowリンパ節転移の再発を認め,再度化学放射線療法(S-1,60 Gy/30 Fr)を施行し,腫大したリンパ節は縮小した。また,術後40か月で縦隔リンパ節に転移を認め化学療法(panitumumab)を施行し,完全奏効を得た。以降,現在まで術後101か月経過しているが,完全奏効を維持し長期生存中である。大腸癌でVirchowリンパ節に転移巣が限局している場合に,化学放射線療法は有効な治療の一つと考えられた。
目次
A 43-year-old man underwent a low anterior resection of the rectum due to upper rectal cancer. The pathological Stage was Ⅳ with para-aortic lymph node metastasis. Postoperative chemotherapy with CapeOX was initiated, but para-aortic lymph node metastasis was discovered 4 months after the surgery. Chemoradiation therapy with Cape and Bev, and 70 Gy/28 Fr led to the disappearance of the metastasized lesions. At 13 months after the surgery, FDG accumulation was observed in the Virchow's lymph node, and chemotherapy with IRIS and Bev was initially administered. Subsequently, chemoradiation therapy with S-1 and Bev, and 66 Gy/33 Fr was administered, followed by chemotherapy with S-1 and Bev, S-1. These therapies led to complete response(CR). However, 35 months after the surgery, the Virchow's lymph node had enlarged again, and chemoradiation therapy with S-1 and 60 Gy/30 Fr was administered. Although no FDG accumulation was detected in the lymph node at 40 months after the surgery, metastasis was found in the mediastinal lymph nodes. Panitumumab therapy achieved CR, and no metastasis had been identified at 60 months after the final therapy. Chemoradiation therapy is a treatment option to improve the prognosis of patients with metastasis only in the Virchow's lymph node.
要旨
症例は43歳,男性。傍大動脈リンパ節転移を伴うStage Ⅳの上部直腸癌に対して直腸低位前方切除術,両側側方リンパ節郭清術,傍大動脈リンパ節サンプリング術を施行した。術後補助化学療法(CapeOX)を施行するも,術後4か月で傍大動脈リンパ節転移を認め,化学放射線療法(Cape+Bev,70 Gy/28 Fr)を施行した。FDGの集積は消失したが,術後13か月でVirchowリンパ節に転移を認めIRIS+Bevを投与した後,化学放射線療法(S-1+Bev,66 Gy/33 Fr),化学療法(S-1+Bev,S-1)を施行し完全奏効を得た。しかし術後35か月にVirchowリンパ節転移の再発を認め,再度化学放射線療法(S-1,60 Gy/30 Fr)を施行し,腫大したリンパ節は縮小した。また,術後40か月で縦隔リンパ節に転移を認め化学療法(panitumumab)を施行し,完全奏効を得た。以降,現在まで術後101か月経過しているが,完全奏効を維持し長期生存中である。大腸癌でVirchowリンパ節に転移巣が限局している場合に,化学放射線療法は有効な治療の一つと考えられた。