内容紹介
Summary
A 77—year—old man was diagnosed with small cell lung cancer(SCLC:cT3N3M1b, Stage ⅣA)with bone metastases 1 year and 9 months ago. Although partial response was obtained after 6 courses of chemotherapy with carboplatin(CBDCA)and etoposide(VP—16), multiple brain metastases were observed 5 months after the completion of chemotherapy. The multiple brain metastases completely disappeared after whole brain irradiation. However, the patient experienced lower extremity weakness, predominantly in the left side, 5 months after irradiation. Contrast—enhanced magnetic resonance imaging(MRI)revealed an abnormal nodular lesion at the Th10 level, indicative of intramedullary spinal cord metastasis originating from the SCLC. After the patient was admitted to our hospital, his neurological symptoms progressed rapidly and he began to experience difficulty in standing, along with bowel and bladder dysfunction. Chemotherapy with CBDCA plus VP—16 improved the neurological symptoms, and MRI after 1 course of chemotherapy revealed a decrease in the size of the metastatic lesion in the spinal cord. Although neurological symptoms are common in patients with lung cancer, intramedullary metastases often promote irreversible neurological dysfunction. Herein, we report a patient with SCLC who developed intramedullary spinal cord metastasis and whose neurological symptoms dramatically improved after systemic chemotherapy.
要旨
症例は77歳,男性。1年9か月前に骨転移を伴う小細胞肺癌(cT3N3M1b, Stage ⅣA)と診断され,化学療法6コース後にpartial responseを得られた。終了5か月後に脳転移を認め,全脳照射により多発性脳転移は消失した。さらに5か月後に左下肢優位の両下肢脱力を生じ,立位保持困難と膀胱直腸障害も出現した。脊髄造影MRI検査にて第10胸椎レベルに胸髄内転移を認めた。化学療法1コース終了時には下肢脱力および膀胱直腸障害は改善し,胸髄内転移病変の縮小が確認された。肺癌の経過中に神経症状が出現することはまれではないが,髄内転移による神経障害は回復が困難なことが多い。今回われわれは,症状出現より早期に診断し化学療法により神経症状の改善が得られた症例を経験したので報告する。
目次
A 77—year—old man was diagnosed with small cell lung cancer(SCLC:cT3N3M1b, Stage ⅣA)with bone metastases 1 year and 9 months ago. Although partial response was obtained after 6 courses of chemotherapy with carboplatin(CBDCA)and etoposide(VP—16), multiple brain metastases were observed 5 months after the completion of chemotherapy. The multiple brain metastases completely disappeared after whole brain irradiation. However, the patient experienced lower extremity weakness, predominantly in the left side, 5 months after irradiation. Contrast—enhanced magnetic resonance imaging(MRI)revealed an abnormal nodular lesion at the Th10 level, indicative of intramedullary spinal cord metastasis originating from the SCLC. After the patient was admitted to our hospital, his neurological symptoms progressed rapidly and he began to experience difficulty in standing, along with bowel and bladder dysfunction. Chemotherapy with CBDCA plus VP—16 improved the neurological symptoms, and MRI after 1 course of chemotherapy revealed a decrease in the size of the metastatic lesion in the spinal cord. Although neurological symptoms are common in patients with lung cancer, intramedullary metastases often promote irreversible neurological dysfunction. Herein, we report a patient with SCLC who developed intramedullary spinal cord metastasis and whose neurological symptoms dramatically improved after systemic chemotherapy.
要旨
症例は77歳,男性。1年9か月前に骨転移を伴う小細胞肺癌(cT3N3M1b, Stage ⅣA)と診断され,化学療法6コース後にpartial responseを得られた。終了5か月後に脳転移を認め,全脳照射により多発性脳転移は消失した。さらに5か月後に左下肢優位の両下肢脱力を生じ,立位保持困難と膀胱直腸障害も出現した。脊髄造影MRI検査にて第10胸椎レベルに胸髄内転移を認めた。化学療法1コース終了時には下肢脱力および膀胱直腸障害は改善し,胸髄内転移病変の縮小が確認された。肺癌の経過中に神経症状が出現することはまれではないが,髄内転移による神経障害は回復が困難なことが多い。今回われわれは,症状出現より早期に診断し化学療法により神経症状の改善が得られた症例を経験したので報告する。