内容紹介
Two Cases of Pancreatic Cancer with Multiple Liver Metastases Treated with Radical Treatment after Successful Treatment with Gemcitabine plus S-1 Therapy
Summary
We report two cases of pancreatic cancer with multiple liver metastases for which successful gemcitabine(GEM)+S-1 therapy facilitated radical resection. Case 1: A 40-year-old man with jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, he was administered GEM+S-1(GEM 1,000 mg/m2 on days 1 and 8; S-1, 100 mg/day for 14 days). Administration of seven courses of therapy achieved complete remission(CR)of the metastatic lesions. Considering the possibility of residual tumors, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Although pathological examination revealed a residual tumor in the primary lesion, R0 resection was achieved. GEM+S-1 therapy was resumed, and the patient is currently relapse-free. Case 2: A 65-year-old man with obstructive jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, GEM+S-1 therapy was initiated. After 11 therapy courses, only one metastatic lesion remained. Radical treatment was then deemed possible, and a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination revealed residual tumors in the primary lesion and the peripancreatic lymph nodes. However, the liver nodules were only fibrotic, and their surgical radicality was R0. GEM+S-1 therapy was resumed, and the patient is currently relapse-free. Conclusion: The high response rate of GEM+S-1 therapy suggests its usefulness in facilitating radical resection after treatment with(GEM)+S-1.
要旨
gemcitabine(GEM)+テガフール・ギメラシル・オテラシルカリウム配合剤(S-1)療法が奏効し,多発肝転移を伴う膵癌が根治切除可能となった2例を報告する。症例1: 40歳,男性。黄疸を契機に多発肝転移を伴う膵頭部癌を指摘された。根治切除不能と判断し,GEM(1,000 mg/m2,day 1,8)+S-1(100 mg/day 1～14 days)療法を施行した。7コース後,転移巣はCRとなった。腫瘍残存を考慮し,SSPPD-ⅡAを施行した。病理結果では原発巣に腫瘍残存がみられたが,R0切除であった。現在GEM+S-1療法を再開し,無再発である。症例2: 65歳,男性。閉塞性黄疸にて多発肝転移を伴う膵頭部癌と診断された。根治切除不能と診断し,GEM+S-1療法を11コース施行。転移巣は1か所のみとなり,根治切除可能と判断しPpPD-ⅡAを施行した。病理結果では原発巣およびNo. 13aリンパ節に腫瘍残存がみられたが,肝の結節は線維化のみでありR0手術であった。現在GEM+S-1療法を再開し,無再発である。GEM+S-1療法はGEM単独療法より奏効率が高く,術前治療の有効な選択肢であると考える。
目次
Summary
We report two cases of pancreatic cancer with multiple liver metastases for which successful gemcitabine(GEM)+S-1 therapy facilitated radical resection. Case 1: A 40-year-old man with jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, he was administered GEM+S-1(GEM 1,000 mg/m2 on days 1 and 8; S-1, 100 mg/day for 14 days). Administration of seven courses of therapy achieved complete remission(CR)of the metastatic lesions. Considering the possibility of residual tumors, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Although pathological examination revealed a residual tumor in the primary lesion, R0 resection was achieved. GEM+S-1 therapy was resumed, and the patient is currently relapse-free. Case 2: A 65-year-old man with obstructive jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, GEM+S-1 therapy was initiated. After 11 therapy courses, only one metastatic lesion remained. Radical treatment was then deemed possible, and a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination revealed residual tumors in the primary lesion and the peripancreatic lymph nodes. However, the liver nodules were only fibrotic, and their surgical radicality was R0. GEM+S-1 therapy was resumed, and the patient is currently relapse-free. Conclusion: The high response rate of GEM+S-1 therapy suggests its usefulness in facilitating radical resection after treatment with(GEM)+S-1.
要旨
gemcitabine(GEM)+テガフール・ギメラシル・オテラシルカリウム配合剤(S-1)療法が奏効し,多発肝転移を伴う膵癌が根治切除可能となった2例を報告する。症例1: 40歳,男性。黄疸を契機に多発肝転移を伴う膵頭部癌を指摘された。根治切除不能と判断し,GEM(1,000 mg/m2,day 1,8)+S-1(100 mg/day 1～14 days)療法を施行した。7コース後,転移巣はCRとなった。腫瘍残存を考慮し,SSPPD-ⅡAを施行した。病理結果では原発巣に腫瘍残存がみられたが,R0切除であった。現在GEM+S-1療法を再開し,無再発である。症例2: 65歳,男性。閉塞性黄疸にて多発肝転移を伴う膵頭部癌と診断された。根治切除不能と診断し,GEM+S-1療法を11コース施行。転移巣は1か所のみとなり,根治切除可能と判断しPpPD-ⅡAを施行した。病理結果では原発巣およびNo. 13aリンパ節に腫瘍残存がみられたが,肝の結節は線維化のみでありR0手術であった。現在GEM+S-1療法を再開し,無再発である。GEM+S-1療法はGEM単独療法より奏効率が高く,術前治療の有効な選択肢であると考える。