内容紹介
A Case of Gastric Cancer with N2 Lymph Node Metastasis and Pancreatic Invasion Effectively Treated with Docetaxel/S-1 as a Neoadjuvant Chemotherapy
Summary
A 74-year-old man was diagnosed with advanced gastric cancer(cStageⅢB). Laparotomy showed N2 lymph node metastasis and pancreatic invasion. Radical resection appeared impossible and was thus not performed. Chemotherapy consisting of a combination of S-1(80 mg/m2, 2-week administration and 1-week rest), and docetaxel(40 mg/m2/day 1)was administered with the expectation of tumor downstaging. A partial response(PR)was obtained after five courses of this regimen in which the primary lesion and lymph node swelling remarkably improved. Total gastrectomy, splenectomy, partial colectomy, and D2 lymph node dissection were then performed. Pathological analysis revealed very few cancer cells in the primary lesion and that the lymph nodes had become scarred and fibrotic. The histological appearance was judged to be grade 2 and the final diagnosis was T1N0H0P0CY0M0, fStageⅠA, curability A. Currently, more than 6 years and 4 months after the operation, the patient is alive without any evidence of recurrence. Thus, docetaxel/S-1 combination therapy was an effective neoadjuvant chemotherapy for this case of advanced gastric cancer.
要旨
症例は74歳,男性。cT3N2M0,cStageⅢBの術前診断で初回手術を施行したが,開腹所見で2群リンパ節腫脹,膵浸潤著明にてsStageⅣと判定し,単開腹にとどめた。術後down staging目的に,外来でdocetaxel(DOC)/S-1併用療法を5コース施行した。投与方法は,DOC 40 mg/m2/day 1,S-1 80 mg/m2/day 1～14を1コースとして3週間ごとに繰り返す投与法を採用した。5コース終了後の効果判定で部分奏効(PR)と判定し,治癒切除可能と判断した。第2回目手術において胃全摘出術,横行結腸,脾臓合併切除を施行した。組織学的効果判定はGrade 2,壁深達度はT1(SM),総合的進行度fStageⅠA,総合的根治度Aであった。術後補助化学療法は行わず,術後6年4か月経過した現在,無再発にて経過中である。DOC/S-1併用療法は,治癒切除が困難な進行胃癌の術前化学療法として有用と考える。
目次
Summary
A 74-year-old man was diagnosed with advanced gastric cancer(cStageⅢB). Laparotomy showed N2 lymph node metastasis and pancreatic invasion. Radical resection appeared impossible and was thus not performed. Chemotherapy consisting of a combination of S-1(80 mg/m2, 2-week administration and 1-week rest), and docetaxel(40 mg/m2/day 1)was administered with the expectation of tumor downstaging. A partial response(PR)was obtained after five courses of this regimen in which the primary lesion and lymph node swelling remarkably improved. Total gastrectomy, splenectomy, partial colectomy, and D2 lymph node dissection were then performed. Pathological analysis revealed very few cancer cells in the primary lesion and that the lymph nodes had become scarred and fibrotic. The histological appearance was judged to be grade 2 and the final diagnosis was T1N0H0P0CY0M0, fStageⅠA, curability A. Currently, more than 6 years and 4 months after the operation, the patient is alive without any evidence of recurrence. Thus, docetaxel/S-1 combination therapy was an effective neoadjuvant chemotherapy for this case of advanced gastric cancer.
要旨
症例は74歳,男性。cT3N2M0,cStageⅢBの術前診断で初回手術を施行したが,開腹所見で2群リンパ節腫脹,膵浸潤著明にてsStageⅣと判定し,単開腹にとどめた。術後down staging目的に,外来でdocetaxel(DOC)/S-1併用療法を5コース施行した。投与方法は,DOC 40 mg/m2/day 1,S-1 80 mg/m2/day 1～14を1コースとして3週間ごとに繰り返す投与法を採用した。5コース終了後の効果判定で部分奏効(PR)と判定し,治癒切除可能と判断した。第2回目手術において胃全摘出術,横行結腸,脾臓合併切除を施行した。組織学的効果判定はGrade 2,壁深達度はT1(SM),総合的進行度fStageⅠA,総合的根治度Aであった。術後補助化学療法は行わず,術後6年4か月経過した現在,無再発にて経過中である。DOC/S-1併用療法は,治癒切除が困難な進行胃癌の術前化学療法として有用と考える。