内容紹介
Summary
Severe stenosis rarely occurs with radiation esophagitis after irradiation. We report our recent experience of a case of recurrent breast cancer in which the patient developed severe esophageal stenosis after receiving combined bevacizumab(Bev)—paclitaxel(PTX)therapy following radiotherapy for a thoracic vertebral metastasis. A 59—year—old woman with Stage ⅢB left breast cancer had undergone total mastectomy with axillary lymph node dissection after receiving neoadjuvant therapy. Elevated carcinoembryonic antigen levels were observed 23 months postoperatively, and multiple bone metastases were detected on PET—CT. After 5 sessions of irradiation with 20 Gy at the Th8—L1 level, combined Bev and PTX plus zoledronic acid was administered. The patient developed dysphagia at the end of the 4 cycles of combined Bev and PTX therapy, and her condition exacerbated subsequently. Therefore, upper gastrointestinal endoscopy was performed, which revealed a circumferential stenosis 31—37 cm from the incisors. We decided to perform the endoscopic treatment. After 3 balloon dilatations, her condition improved, and oral ingestion was possible. The esophageal stenosis might have been caused by the exacerbation of esophagitis because of the delayed wound healing effect of Bev in addition to radiation.
要旨
放射線照射後の放射線食道炎で高度の狭窄を来すことはまれである。この度,乳癌の胸椎転移に対する緩和的放射線照射後にベバシズマブ(Bev)+パクリタキセル(PTX)療法を施行し,高度食道狭窄を来した再発乳癌を経験したので報告する。症例は59歳,女性。Stage ⅢB左乳癌に対し術前化学療法後にBt+Axを施行した。術後23か月経過後にCEAの上昇を認め,PET—CT検査にて多発骨転移が認められた。Th8～L1に20 Gy/5回の放射線照射を行った後,Bev+PTX療法+ゾレドロン酸を投与した。Bev+PTX療法を4サイクル終了後に嚥下困難を訴えはじめ,以後,症状が増悪したため上部内視鏡検査を施行した。内視鏡所見は切歯より31～37 cmの胸部食道に全周性の狭窄を認め,内視鏡的治療を行うこととしバルーン拡張術を3回施行し,経口摂取可能なまでに回復した。食道狭窄の原因として放射線に加えBevの創傷治癒遅延作用により食道炎が増悪した可能性があることが考えられた。
目次
Severe stenosis rarely occurs with radiation esophagitis after irradiation. We report our recent experience of a case of recurrent breast cancer in which the patient developed severe esophageal stenosis after receiving combined bevacizumab(Bev)—paclitaxel(PTX)therapy following radiotherapy for a thoracic vertebral metastasis. A 59—year—old woman with Stage ⅢB left breast cancer had undergone total mastectomy with axillary lymph node dissection after receiving neoadjuvant therapy. Elevated carcinoembryonic antigen levels were observed 23 months postoperatively, and multiple bone metastases were detected on PET—CT. After 5 sessions of irradiation with 20 Gy at the Th8—L1 level, combined Bev and PTX plus zoledronic acid was administered. The patient developed dysphagia at the end of the 4 cycles of combined Bev and PTX therapy, and her condition exacerbated subsequently. Therefore, upper gastrointestinal endoscopy was performed, which revealed a circumferential stenosis 31—37 cm from the incisors. We decided to perform the endoscopic treatment. After 3 balloon dilatations, her condition improved, and oral ingestion was possible. The esophageal stenosis might have been caused by the exacerbation of esophagitis because of the delayed wound healing effect of Bev in addition to radiation.
要旨
放射線照射後の放射線食道炎で高度の狭窄を来すことはまれである。この度,乳癌の胸椎転移に対する緩和的放射線照射後にベバシズマブ(Bev)+パクリタキセル(PTX)療法を施行し,高度食道狭窄を来した再発乳癌を経験したので報告する。症例は59歳,女性。Stage ⅢB左乳癌に対し術前化学療法後にBt+Axを施行した。術後23か月経過後にCEAの上昇を認め,PET—CT検査にて多発骨転移が認められた。Th8～L1に20 Gy/5回の放射線照射を行った後,Bev+PTX療法+ゾレドロン酸を投与した。Bev+PTX療法を4サイクル終了後に嚥下困難を訴えはじめ,以後,症状が増悪したため上部内視鏡検査を施行した。内視鏡所見は切歯より31～37 cmの胸部食道に全周性の狭窄を認め,内視鏡的治療を行うこととしバルーン拡張術を3回施行し,経口摂取可能なまでに回復した。食道狭窄の原因として放射線に加えBevの創傷治癒遅延作用により食道炎が増悪した可能性があることが考えられた。