内容紹介
Summary
A 70—year—old man had undergone thoracoscopic esophagectomy following neoadjuvant chemotherapy for thoracic esophageal squamous cell carcinoma 3 years before presentation. He was undergoing whole—brain irradiation following surgery for a solitary brain metastatic tumor. The chief complaint was left leg pain during irradiation. FDG—PET/CT and MRI revealed metastases in bilateral cauda equina S1 nerve roots. Cerebrospinal fluid examination also revealed malignant cells. He received chemotherapy with 2 courses of 5—fluorouracil and cisplatin following 30 Gy of spinal irradiation. To control neurological symptoms, 4 courses of intrathecal chemotherapy with methotrexate, cytarabine, and betamethasone were performed. However, he gradually weakened and died 8 months after brain metastasis and 7 months after leptomeningeal carcinomatosis. The multidisciplinary treatment using irradiation and systemic and intrathecal chemotherapies could improve the survival of patients with leptomeningeal carcinomatosis of esophageal squamous cell carcinoma.
要旨
症例は70歳,男性。胸部食道扁平上皮癌術後3年目に孤立性脳転移で開頭腫瘍摘出術と全脳照射を受けた。照射後左下肢痛のためFDG—PET/CT検査と造影MRI検査を行い,脊髄左右S1転移を指摘され,髄液検査にて癌性髄膜症と診断された。脊髄照射,5—FU+シスプラチン(FP)療法後も髄膜症以外の再発は認めなかった。その後,脳転移の診断から8か月で死亡する直前までメソトレキセート,シタラビンの髄腔内投与を行いながら脳神経学的症状の増悪と改善を繰り返しながらも予後を延長することができた。
目次
A 70—year—old man had undergone thoracoscopic esophagectomy following neoadjuvant chemotherapy for thoracic esophageal squamous cell carcinoma 3 years before presentation. He was undergoing whole—brain irradiation following surgery for a solitary brain metastatic tumor. The chief complaint was left leg pain during irradiation. FDG—PET/CT and MRI revealed metastases in bilateral cauda equina S1 nerve roots. Cerebrospinal fluid examination also revealed malignant cells. He received chemotherapy with 2 courses of 5—fluorouracil and cisplatin following 30 Gy of spinal irradiation. To control neurological symptoms, 4 courses of intrathecal chemotherapy with methotrexate, cytarabine, and betamethasone were performed. However, he gradually weakened and died 8 months after brain metastasis and 7 months after leptomeningeal carcinomatosis. The multidisciplinary treatment using irradiation and systemic and intrathecal chemotherapies could improve the survival of patients with leptomeningeal carcinomatosis of esophageal squamous cell carcinoma.
要旨
症例は70歳,男性。胸部食道扁平上皮癌術後3年目に孤立性脳転移で開頭腫瘍摘出術と全脳照射を受けた。照射後左下肢痛のためFDG—PET/CT検査と造影MRI検査を行い,脊髄左右S1転移を指摘され,髄液検査にて癌性髄膜症と診断された。脊髄照射,5—FU+シスプラチン(FP)療法後も髄膜症以外の再発は認めなかった。その後,脳転移の診断から8か月で死亡する直前までメソトレキセート,シタラビンの髄腔内投与を行いながら脳神経学的症状の増悪と改善を繰り返しながらも予後を延長することができた。