内容紹介
Gastric Cancer with Liver Metastasis and Peritoneal Dissemination Treated with Conversion Surgery to Achieve R0 Resection after Capecitabine, Cisplatin, and Trastuzumab Chemotherapy―A Case Report
Summary
Herein, we present a case report suggesting the importance of conversion surgery and the effectiveness of adjuvant chemotherapy with trastuzumab. A 77-year-old woman was diagnosed with gastric cancer complicated by multiple liver metastases and peritoneal dissemination. Owing to a HER2 immunohistochemistry(IHC)tumor score of 3+, we initiated capecitabine plus cisplatin(CDDP)plus trastuzumab chemotherapy. Subsequently, the liver metastases and peritoneal dissemination were absent on computed tomography images, and no new metastatic lesions developed during chemotherapy. After 10 chemotherapy courses, the patient underwent distal gastrectomy and 2 partial liver resection procedures. The liver metastasis remained, and it received a score of 2+ on the HER2 IHC test. We have continued to administer postoperative capecitabine plus trastuzumab chemotherapy because no metastatic lesions have appeared.
要旨
症例は77歳,女性。胃体下部大弯の2型進行胃癌を指摘され,精査にて多発肝転移および腹膜播種を認めた。生検にてHER2 IHC 3+であったため,capecitabine+CDDP+trastuzumabによる化学療法を行った。CT上肝転移と腹膜播種は消失し,その後の化学療法継続にても新規病変は出現しなかったため計10コースの化学療法後,幽門側胃切除術,2か所の肝部分切除術を行った。術後診断はypT3(SS)N0M1P0CY0H1,ypStageⅣであり,組織学的効果判定はGrade 1a,切除した原発巣・肝転移巣ともにHER2 IHC 2+であった。術後はcapecitabine+trastuzumabによる化学療法を継続しており,術後2年間無再発生存中である。conversion surgeryの重要性ならびに術後化学療法としてもtrastuzumabの有効性を示唆する症例と考えられたため報告する。
目次
Summary
Herein, we present a case report suggesting the importance of conversion surgery and the effectiveness of adjuvant chemotherapy with trastuzumab. A 77-year-old woman was diagnosed with gastric cancer complicated by multiple liver metastases and peritoneal dissemination. Owing to a HER2 immunohistochemistry(IHC)tumor score of 3+, we initiated capecitabine plus cisplatin(CDDP)plus trastuzumab chemotherapy. Subsequently, the liver metastases and peritoneal dissemination were absent on computed tomography images, and no new metastatic lesions developed during chemotherapy. After 10 chemotherapy courses, the patient underwent distal gastrectomy and 2 partial liver resection procedures. The liver metastasis remained, and it received a score of 2+ on the HER2 IHC test. We have continued to administer postoperative capecitabine plus trastuzumab chemotherapy because no metastatic lesions have appeared.
要旨
症例は77歳,女性。胃体下部大弯の2型進行胃癌を指摘され,精査にて多発肝転移および腹膜播種を認めた。生検にてHER2 IHC 3+であったため,capecitabine+CDDP+trastuzumabによる化学療法を行った。CT上肝転移と腹膜播種は消失し,その後の化学療法継続にても新規病変は出現しなかったため計10コースの化学療法後,幽門側胃切除術,2か所の肝部分切除術を行った。術後診断はypT3(SS)N0M1P0CY0H1,ypStageⅣであり,組織学的効果判定はGrade 1a,切除した原発巣・肝転移巣ともにHER2 IHC 2+であった。術後はcapecitabine+trastuzumabによる化学療法を継続しており,術後2年間無再発生存中である。conversion surgeryの重要性ならびに術後化学療法としてもtrastuzumabの有効性を示唆する症例と考えられたため報告する。