内容紹介
A Case of Long-Term Survival after Low-Dose FP Systemic Chemotherapy for a Tumor Thrombus in the Inferior Caval Vein and Multiple Lung Metastases from Recurrent Hepatocellular Carcinoma
Summary
We report a case of long-term survival of a patient who received low-dose 5-fluorouracil and cisplatin(FP)systemic chemotherapy and underwent partial resection of the lung for a tumor thrombus in the inferior caval vein(IVC)and multiple lung metastases from recurrent hepatocellular carcinoma(HCC). The patient was a 66-year-old man who was admitted to our hospital for the treatment of a 13-cm liver tumor. He underwent an extended posterior sectionectomy of the liver. Pathological diagnosis revealed moderately differentiated hepatocellular carcinoma(vp1, vv1, sm[-, 1.5 mm], ch, T3N0M0, stageⅢ). At 3 months postoperatively, computed tomography(CT)revealed a tumor thrombus in the IVC and multiple(>20)lung tumors that were considered HCC recurrences. Low-dose FP systemic chemotherapy was initiated, and the tumors reduced in size. However, a new lesion in the left lung was detected at 13 months postoperatively. Thoracoscopy-assisted resection of the tumor that was histologically diagnosed as an HCC metastasis was performed at 26 months postoperatively. The patient is cancer free at 46 months postoperatively. Therefore, low-dose FP systemic chemotherapy is one of the therapeutic options for the treatment of HCC recurrences of IVC tumor thrombi and multiple lung metastases. However, the occurrence of new lesions should be carefully monitored.
要旨
肝細胞癌(HCC)に対する肝切除術後に下大静脈(IVC)内腫瘍栓,多発肺転移で再発し,low-dose FP全身化学療法と肺切除によりcancer freeとなった症例を経験したので報告する。症例は66歳,男性。右側腹部痛を主訴に近医受診し,US・CTで肝後区域に径13 cmの腫瘍を指摘され,当科紹介入院。HCCの診断で拡大後区域切除を受けた。病理診断は中分化型HCC[vp1,vv1,sm(-,1.5 mm),ch,f1,T3N0M0,stageⅢ]であった。術後3か月目に,CTでIVC内に腫瘍栓と両側肺に合計20個以上の腫瘤を認めた。HCC再発の診断でlow-dose FP全身化学療法を開始した。画像上腫瘍の縮小を認めたが,術後13か月目に左肺S3にnew lesionが出現しこの病変のみ増大したため,術後26か月目で左肺上葉部分切除施行。病理診断はHCCの肺転移であった。肝切除術後46か月の時点でcancer freeとなっている。HCCに対する肝切除後のIVC内腫瘍栓,多発肺転移再発に対しlow-dose FP全身化学療法は考慮すべき治療法と考えられるが,新病変にも注意が必要である。
目次
Summary
We report a case of long-term survival of a patient who received low-dose 5-fluorouracil and cisplatin(FP)systemic chemotherapy and underwent partial resection of the lung for a tumor thrombus in the inferior caval vein(IVC)and multiple lung metastases from recurrent hepatocellular carcinoma(HCC). The patient was a 66-year-old man who was admitted to our hospital for the treatment of a 13-cm liver tumor. He underwent an extended posterior sectionectomy of the liver. Pathological diagnosis revealed moderately differentiated hepatocellular carcinoma(vp1, vv1, sm[-, 1.5 mm], ch, T3N0M0, stageⅢ). At 3 months postoperatively, computed tomography(CT)revealed a tumor thrombus in the IVC and multiple(>20)lung tumors that were considered HCC recurrences. Low-dose FP systemic chemotherapy was initiated, and the tumors reduced in size. However, a new lesion in the left lung was detected at 13 months postoperatively. Thoracoscopy-assisted resection of the tumor that was histologically diagnosed as an HCC metastasis was performed at 26 months postoperatively. The patient is cancer free at 46 months postoperatively. Therefore, low-dose FP systemic chemotherapy is one of the therapeutic options for the treatment of HCC recurrences of IVC tumor thrombi and multiple lung metastases. However, the occurrence of new lesions should be carefully monitored.
要旨
肝細胞癌(HCC)に対する肝切除術後に下大静脈(IVC)内腫瘍栓,多発肺転移で再発し,low-dose FP全身化学療法と肺切除によりcancer freeとなった症例を経験したので報告する。症例は66歳,男性。右側腹部痛を主訴に近医受診し,US・CTで肝後区域に径13 cmの腫瘍を指摘され,当科紹介入院。HCCの診断で拡大後区域切除を受けた。病理診断は中分化型HCC[vp1,vv1,sm(-,1.5 mm),ch,f1,T3N0M0,stageⅢ]であった。術後3か月目に,CTでIVC内に腫瘍栓と両側肺に合計20個以上の腫瘤を認めた。HCC再発の診断でlow-dose FP全身化学療法を開始した。画像上腫瘍の縮小を認めたが,術後13か月目に左肺S3にnew lesionが出現しこの病変のみ増大したため,術後26か月目で左肺上葉部分切除施行。病理診断はHCCの肺転移であった。肝切除術後46か月の時点でcancer freeとなっている。HCCに対する肝切除後のIVC内腫瘍栓,多発肺転移再発に対しlow-dose FP全身化学療法は考慮すべき治療法と考えられるが,新病変にも注意が必要である。