Second-lineにpaclitaxelの併用で長期のS-1投与が有用であった胃癌腹膜転移の1例

われわれはS-1の反応が悪くなった胃癌腹膜転移の1例に2nd-line chemotherapyとしてpaclitaxelを併用して有効であったことを報告する.投与方法はS-1 80mg/日3週連日経口投与+paclitaxel 40mg/m^2をday 1, 8, 15に点滴静脈注射し, 2週休薬する5週間1コースの併用である.主に外来化学療法として行った.症例の腹膜転移を有する4型胃癌に対し,胃全摘+脾合併切除術, D2郭清を施行した.術後S-1を12コース投与した. CTで右横隔膜下に腹膜転移の増強と肝門部に再発の増大を認めたため, paclitaxelを併用した.併用11コース後,肝門部再発が徐々に軽度増大したが,腹膜転移は不変で,長期間にわたって全身状態は良好であった.腹膜転移診断後3年7ヵ月でご永眠された. S-1の反応が悪くなった胃癌腹膜転移例に2nd-line chemotherapyとしてpaclitaxelを併用して生存期間をさらに延長したと考えられる.この化学療法は重症な副作用がなく,外来で頻用できる有効な治療である.We describe a patient with peritoneal metastasis from gastric cancer treated with S-1 (TS-1^) in whom survival was further prolonged by concomitant treatment with paclitaxel (Taxol^), given as second-line chemotherapy. S-1 (80mg/day) was given orally for 21 days, and paclitaxel (40mg/m^2) was given by intravenous infusion on days 1, 8, and 15 of a 5-week cycle, administered primarily on an outpatient basis. A 61-year-old man presented with body weight loss. Type 4 gastric cancer was diagnosed on endoscopic examination. The patient underwent total gastrectomy for gastric cancer with peritoneal metastasis. Twelve cycles of S-1 were given postoperatively. A computed tomographic scan revealed increased peritoneal metastasis and disease recurrence. Paclitaxel was therefore given concomitantly with S-1. After 11 cycles of combination chemotherapy, peritoneal metastasis remained unchanged. The patient died 3 years 7 months after the diagnosis of peritoneal metastasis. In the patient with gastric cancer and peritoneal metastasis relatively refractory to S-1 therapy, the combination of a low weekly dose of paclitaxel and S-1 prolonged survival further without severe toxicity. We conclude that this regimen can be given for many cycles on an outpatient basis and prolong survival

Second-lineにpaclitaxelの併用で長期のS-1投与が有用であった胃癌腹膜転移の1例

われわれはS-1の反応が悪くなった胃癌腹膜転移の1例に2nd-line chemotherapyとしてpaclitaxelを併用して有効であったことを報告する.投与方法はS-1 80mg/日3週連日経口投与+paclitaxel 40mg/m^2をday 1, 8, 15に点滴静脈注射し, 2週休薬する5週間1コースの併用である.主に外来化学療法として行った.症例の腹膜転移を有する4型胃癌に対し,胃全摘+脾合併切除術, D2郭清を施行した.術後S-1を12コース投与した. CTで右横隔膜下に腹膜転移の増強と肝門部に再発の増大を認めたため, paclitaxelを併用した.併用11コース後,肝門部再発が徐々に軽度増大したが,腹膜転移は不変で,長期間にわたって全身状態は良好であった.腹膜転移診断後3年7ヵ月でご永眠された. S-1の反応が悪くなった胃癌腹膜転移例に2nd-line chemotherapyとしてpaclitaxelを併用して生存期間をさらに延長したと考えられる.この化学療法は重症な副作用がなく,外来で頻用できる有効な治療である.We describe a patient with peritoneal metastasis from gastric cancer treated with S-1 (TS-1^<[○!R]>) in whom survival was further prolonged by concomitant treatment with paclitaxel (Taxol^<[○!R]>), given as second-line chemotherapy. S-1 (80mg/day) was given orally for 21 days, and paclitaxel (40mg/m^2) was given by intravenous infusion on days 1, 8, and 15 of a 5-week cycle, administered primarily on an outpatient basis. A 61-year-old man presented with body weight loss. Type 4 gastric cancer was diagnosed on endoscopic examination. The patient underwent total gastrectomy for gastric cancer with peritoneal metastasis. Twelve cycles of S-1 were given postoperatively. A computed tomographic scan revealed increased peritoneal metastasis and disease recurrence. Paclitaxel was therefore given concomitantly with S-1. After 11 cycles of combination chemotherapy, peritoneal metastasis remained unchanged. The patient died 3 years 7 months after the diagnosis of peritoneal metastasis. In the patient with gastric cancer and peritoneal metastasis relatively refractory to S-1 therapy, the combination of a low weekly dose of paclitaxel and S-1 prolonged survival further without severe toxicity. We conclude that this regimen can be given for many cycles on an outpatient basis and prolong survival

直腸原発GIST(gastrointestinal stromal tumor)の2例

直腸原発gastrointestinal stromal tumor(GIST)の2例を経験したので報告する.症例1は44歳男性である.直腸平滑筋肉腫に診断で,腹会陰式直腸切断術(APR)を施行した.補助療法は行わず,術後7年8カ月目にS3肝転移を認め,肝外側区域切除を行い,現在生存中である.症例2は43歳男性である.術中迅速病理診断で直腸平滑筋肉腫の確定診断を得たため,APRを行った.術後2年目に局所再発および多発肝転移を来し,術後4年目には肺転移を認めた.CT下マイクロウェーブ凝固療法,化学療法,TAEで加療を行ったが,術後5年3カ月目に死亡した.両症例に後日免疫組織化学染色を施工し,c-kitおよびCD34が強陽性を示していたことから狭義のGISTと診断された.直腸原発GISTの症例の報告は少ない.本邦における直腸GISTの報告例とともに,若干の文献的考察を加え報告する.Two cases of gastrointestinal stromal tumor (GIST) originating in the rectum are reported. The first patient was a 44-year-old man (Case 1) who underwent abdominoperineal resection (APR) for a diagnosis of smooth muscle sarcoma of the rectum. No adjuvant therapy was administered. Seven years 8 months after the operation, hepatic metastasis (S3 region of the liver) was diagnosed, and excision of the lateral segment of the liver was performed. The patient is alive 5 months after the operation. The second patient was a 43-year-old man (Case 2) with smooth muscle sarcoma of the rectum diagnosed by intraoperative frozen section examination, and APR was performed. Two years after the operation, local recurrence and multiple hepatic metastases were diagnosed. Two years later, metastasis to the lung was diagnosed. The patient was treated by microwave coagulation therapy under CT guidance for local recurrence and TAE for liver metastasis, and systemic chemotherapy, but died 5 years and 3 months after the operation. Immunohistchemical staining of the tumor specimens obtained from these patients revealed that the tumors were strongly c-kit- and CD34-positive, clear evidence for a diagnosis of GIST. Since there have been few reports in the literature of patients with recurrence or metastasis of definite GIST originating in the rectum, we report our two cases of rectal GIST

直腸原発GIST(gastrointestinal stromal tumor)の2例

直腸原発gastrointestinal stromal tumor(GIST)の2例を経験したので報告する.症例1は44歳男性である.直腸平滑筋肉腫に診断で,腹会陰式直腸切断術(APR)を施行した.補助療法は行わず,術後7年8カ月目にS3肝転移を認め,肝外側区域切除を行い,現在生存中である.症例2は43歳男性である.術中迅速病理診断で直腸平滑筋肉腫の確定診断を得たため,APRを行った.術後2年目に局所再発および多発肝転移を来し,術後4年目には肺転移を認めた.CT下マイクロウェーブ凝固療法,化学療法,TAEで加療を行ったが,術後5年3カ月目に死亡した.両症例に後日免疫組織化学染色を施工し,c-kitおよびCD34が強陽性を示していたことから狭義のGISTと診断された.直腸原発GISTの症例の報告は少ない.本邦における直腸GISTの報告例とともに,若干の文献的考察を加え報告する.Two cases of gastrointestinal stromal tumor (GIST) originating in the rectum are reported. The first patient was a 44-year-old man (Case 1) who underwent abdominoperineal resection (APR) for a diagnosis of smooth muscle sarcoma of the rectum. No adjuvant therapy was administered. Seven years 8 months after the operation, hepatic metastasis (S3 region of the liver) was diagnosed, and excision of the lateral segment of the liver was performed. The patient is alive 5 months after the operation. The second patient was a 43-year-old man (Case 2) with smooth muscle sarcoma of the rectum diagnosed by intraoperative frozen section examination, and APR was performed. Two years after the operation, local recurrence and multiple hepatic metastases were diagnosed. Two years later, metastasis to the lung was diagnosed. The patient was treated by microwave coagulation therapy under CT guidance for local recurrence and TAE for liver metastasis, and systemic chemotherapy, but died 5 years and 3 months after the operation. Immunohistchemical staining of the tumor specimens obtained from these patients revealed that the tumors were strongly c-kit- and CD34-positive, clear evidence for a diagnosis of GIST. Since there have been few reports in the literature of patients with recurrence or metastasis of definite GIST originating in the rectum, we report our two cases of rectal GIST

高位S状結腸癌に対する術式の工夫

浜野恭一教授退任記念論文