内容紹介
A Case of Early Gastric Cancer with Multiple Synchronous Bone Metastases Treated Complete Response with S-1+CDDP
Summary
We report a case of complete response(CR)following induction chemotherapy using S-1 for a patient with early gastric cancer accompanied by multiple synchronous bone metastases. An asymptomatic 70-year-old woman was diagnosed with early gastric cancer by upper gastrointestinal endoscopy during a periodic medical examination. An abdomino-pelvic computed tomography(CT)scan revealed no primary tumor in the stomach and the absence of lymph node or liver metastases. However, osteoplastic changes were detected in the lumbar vertebrae and the ilium. Multiple synchronous bone metastases from early gastric cancer were detected on magnetic resonance imaging, bone scintigraphy, and positron emission tomography-CT. After a regimen consisting of 15 courses of S-1 plus cisplatin(CDDP), and an additional 5 courses of S-1 were administered, clinical CR was confirmed for the bone metastases. Laparoscopic distal gastrectomy with D1 lymphadenectomy was performed for treating the primary gastric cancer 33 months after the initiation of chemotherapy. Pathological CR was also achieved for the primary gastric cancer. Imaging analysis did not show disease progression 48 months after the initiation of chemotherapy. Synchronous bone metastases from early gastric cancer are extremely rare, and a good outcome was achieved in the present case through induction chemotherapy.
要旨
多発骨転移を伴う早期胃癌に対して,化学療法で完全寛解(CR)を得られた症例を報告する。症例は70歳,女性。定期検診の上部消化管内視鏡で早期胃癌の診断となった。腹部骨盤部CT検査所見では原発巣は示現できず,リンパ節転移や肝転移は認めなかったが,腰椎,腸骨に多発する骨硬化所見を認めた。全身精査で他の重複癌は認めず,MRI,骨シンチグラフィ検査で胃癌の同時性多発骨転移と診断した。S-1+CDDPを15コースおよびS-1単剤を5コース行い,画像上,骨転移がCRとなった。化学療法開始33か月後に,原発巣の胃癌に対して腹腔鏡下幽門側胃切除術,D1郭清を行った。病理診断では,原発巣は組織学的なCRであった。現在,化学療法を開始後48か月が経過し,骨転移の再燃の所見は認めていない。早期胃癌の同時性骨転移自体が極めてまれであり,また化学療法が奏効した貴重な1例である。
目次
Summary
We report a case of complete response(CR)following induction chemotherapy using S-1 for a patient with early gastric cancer accompanied by multiple synchronous bone metastases. An asymptomatic 70-year-old woman was diagnosed with early gastric cancer by upper gastrointestinal endoscopy during a periodic medical examination. An abdomino-pelvic computed tomography(CT)scan revealed no primary tumor in the stomach and the absence of lymph node or liver metastases. However, osteoplastic changes were detected in the lumbar vertebrae and the ilium. Multiple synchronous bone metastases from early gastric cancer were detected on magnetic resonance imaging, bone scintigraphy, and positron emission tomography-CT. After a regimen consisting of 15 courses of S-1 plus cisplatin(CDDP), and an additional 5 courses of S-1 were administered, clinical CR was confirmed for the bone metastases. Laparoscopic distal gastrectomy with D1 lymphadenectomy was performed for treating the primary gastric cancer 33 months after the initiation of chemotherapy. Pathological CR was also achieved for the primary gastric cancer. Imaging analysis did not show disease progression 48 months after the initiation of chemotherapy. Synchronous bone metastases from early gastric cancer are extremely rare, and a good outcome was achieved in the present case through induction chemotherapy.
要旨
多発骨転移を伴う早期胃癌に対して,化学療法で完全寛解(CR)を得られた症例を報告する。症例は70歳,女性。定期検診の上部消化管内視鏡で早期胃癌の診断となった。腹部骨盤部CT検査所見では原発巣は示現できず,リンパ節転移や肝転移は認めなかったが,腰椎,腸骨に多発する骨硬化所見を認めた。全身精査で他の重複癌は認めず,MRI,骨シンチグラフィ検査で胃癌の同時性多発骨転移と診断した。S-1+CDDPを15コースおよびS-1単剤を5コース行い,画像上,骨転移がCRとなった。化学療法開始33か月後に,原発巣の胃癌に対して腹腔鏡下幽門側胃切除術,D1郭清を行った。病理診断では,原発巣は組織学的なCRであった。現在,化学療法を開始後48か月が経過し,骨転移の再燃の所見は認めていない。早期胃癌の同時性骨転移自体が極めてまれであり,また化学療法が奏効した貴重な1例である。