内容紹介
Summary
We report a case of unresectable advanced esophagogastric junction carcinoma that was treated with nab—paclitaxel and ramucirumab, which resulted in complete response and salvage surgery. A 57—year—old male complained of upper abdominal discomfort. While attending a hospital for diabetes mellitus, upper gastrointestinal endoscopy was performed. A tumor protruding from the gastric cardia to the abdominal esophagus was found, and histological examination revealed well—differentiated adenocarcinoma. Multiple liver metastases and para—aortic lymph node metastases were found on abdominal contrast—enhanced CT. The patient was diagnosed with stage Ⅳ cancer, and chemotherapy was performed as unresectable advanced esophagogastric junction carcinoma. S—1 plus CDDP therapy was started as the first—line treatment. After 2 courses of S—1 plus CDDP therapy, tumor markers were elevated. Further, the cancer was judged to be highly toxic and refractory to treatment;therefore, we started nab—paclitaxel and ramucirumab as the secondary treatment. After 4 courses, normalization of tumor markers, disappearance of liver metastases, and marked reduction of enlarged lymph nodes were observed. However, PET—CT showed increased uptake, consistent with the primary lesion. Residual cancer could not be ruled—out;therefore, total gastrectomy was performed. Histopathological examination of the surgically resected specimen showed no residual tumors.
要旨
切除不能進行食道胃接合部癌に対しnab—paclitaxel+ramucirumab(nab—PTX+RAM)療法が著効しCRが得られ,サルベージ手術を実施し得た症例を経験したので報告する。症例は57歳,男性。糖尿病で通院中に上腹部の違和感を訴えたため,上部消化管内視鏡検査を施行した。胃噴門部から腹部食道に突出する腫瘍を指摘され,組織検査で高分化型腺癌の診断であった。腹部造影CT検査にて多発肝転移,傍大動脈リンパ節転移を認めたためstage Ⅳと診断し,切除不能進行食道胃接合部癌として化学療法の方針とした。一次治療として,まずS—1+CDDP療法を開始した。2コース実施したところで腫瘍マーカーの上昇を認め,また毒性が強く不応不耐であると判断し,二次治療としてnab—PTX+RAM療法を開始した。4コース後に腫瘍マーカーの正常化,肝転移巣の消失,腫大リンパ節の著明な縮小を認めた。しかしPET—CTで原発巣に一致した集積亢進が残存するため癌の遺残を否定できず,胃全摘を実施した。手術摘出標本の病理組織学的検査結果では癌の遺残を認めなかった。
目次
We report a case of unresectable advanced esophagogastric junction carcinoma that was treated with nab—paclitaxel and ramucirumab, which resulted in complete response and salvage surgery. A 57—year—old male complained of upper abdominal discomfort. While attending a hospital for diabetes mellitus, upper gastrointestinal endoscopy was performed. A tumor protruding from the gastric cardia to the abdominal esophagus was found, and histological examination revealed well—differentiated adenocarcinoma. Multiple liver metastases and para—aortic lymph node metastases were found on abdominal contrast—enhanced CT. The patient was diagnosed with stage Ⅳ cancer, and chemotherapy was performed as unresectable advanced esophagogastric junction carcinoma. S—1 plus CDDP therapy was started as the first—line treatment. After 2 courses of S—1 plus CDDP therapy, tumor markers were elevated. Further, the cancer was judged to be highly toxic and refractory to treatment;therefore, we started nab—paclitaxel and ramucirumab as the secondary treatment. After 4 courses, normalization of tumor markers, disappearance of liver metastases, and marked reduction of enlarged lymph nodes were observed. However, PET—CT showed increased uptake, consistent with the primary lesion. Residual cancer could not be ruled—out;therefore, total gastrectomy was performed. Histopathological examination of the surgically resected specimen showed no residual tumors.
要旨
切除不能進行食道胃接合部癌に対しnab—paclitaxel+ramucirumab(nab—PTX+RAM)療法が著効しCRが得られ,サルベージ手術を実施し得た症例を経験したので報告する。症例は57歳,男性。糖尿病で通院中に上腹部の違和感を訴えたため,上部消化管内視鏡検査を施行した。胃噴門部から腹部食道に突出する腫瘍を指摘され,組織検査で高分化型腺癌の診断であった。腹部造影CT検査にて多発肝転移,傍大動脈リンパ節転移を認めたためstage Ⅳと診断し,切除不能進行食道胃接合部癌として化学療法の方針とした。一次治療として,まずS—1+CDDP療法を開始した。2コース実施したところで腫瘍マーカーの上昇を認め,また毒性が強く不応不耐であると判断し,二次治療としてnab—PTX+RAM療法を開始した。4コース後に腫瘍マーカーの正常化,肝転移巣の消失,腫大リンパ節の著明な縮小を認めた。しかしPET—CTで原発巣に一致した集積亢進が残存するため癌の遺残を否定できず,胃全摘を実施した。手術摘出標本の病理組織学的検査結果では癌の遺残を認めなかった。