内容紹介
A Case of Advanced Rectal Cancer with Bladder Carcinoma Salvaged from Myocardial Infarction during Operation, Showing Tumor Regression by XELOX Treatment, Good Quality of Life
Summary
We report a case of advanced rectal cancer with bladder carcinoma. The patient was a 81-year-old man who complained of abdominal bloating. A colonoscopy showed that he had advanced lower rectal cancer. CT scan revealed many lymph node metastases around the tumor, and also a bladder tumor. He experienced myocardial infarction during the operation but was relieved by PCI. During the operation, sigmoid colostomy was performed. The curative operation was declined and chemotherapy was selected. Capecitabine(2,000 mg/m2, biweekly)plus oxaliplatin(130 mg/m2, day 1)was selected. At first, he complained of peripheral vein pain. The speed of oxaliplatin infusion was slowed and the pain was relieved. He had Grade 3 platelet decrease, but the number improved after 3 weeks. The tumor marker decreased after 3 courses, 6 courses after CT scan revealed that the tumor and lymph node metastases had evidently decreased. Capecitabine plus oxaliplatin(XELOX)was considered to be a useful chemotherapy against advanced rectal cancer, even for older patients or high risk groups.
要旨
症例は81歳,男性。進行直腸癌の診断で腹会陰式直腸切断術による根治的手術を予定したが,術中血圧の低下を認め,人工肛門を造設しただけで手術を終了した。術後に緊急心臓カテーテル検査にて急性心筋梗塞と診断され,PCIにて治療した。根治的手術は断念し,化学療法を行うこととなり,術後25日目よりcapecitabine(2,000 mg/m2)2週間投与1週間休薬,oxaliplatin(130 mg/m2)day 1投与を行った。腹部CTにて直腸壁の肥厚の改善,周囲リンパ節腫脹の縮小および腫瘍マーカーの減少を認め,1年4か月の間良好なQOLを保ちつつ,病勢コントロールができた。XELOX初期導入時の症例ではあったが,心筋梗塞後のハイリスクな症例に対してXELOX療法は安全に施行でき,良好なコントロールが得られた。
目次
Summary
We report a case of advanced rectal cancer with bladder carcinoma. The patient was a 81-year-old man who complained of abdominal bloating. A colonoscopy showed that he had advanced lower rectal cancer. CT scan revealed many lymph node metastases around the tumor, and also a bladder tumor. He experienced myocardial infarction during the operation but was relieved by PCI. During the operation, sigmoid colostomy was performed. The curative operation was declined and chemotherapy was selected. Capecitabine(2,000 mg/m2, biweekly)plus oxaliplatin(130 mg/m2, day 1)was selected. At first, he complained of peripheral vein pain. The speed of oxaliplatin infusion was slowed and the pain was relieved. He had Grade 3 platelet decrease, but the number improved after 3 weeks. The tumor marker decreased after 3 courses, 6 courses after CT scan revealed that the tumor and lymph node metastases had evidently decreased. Capecitabine plus oxaliplatin(XELOX)was considered to be a useful chemotherapy against advanced rectal cancer, even for older patients or high risk groups.
要旨
症例は81歳,男性。進行直腸癌の診断で腹会陰式直腸切断術による根治的手術を予定したが,術中血圧の低下を認め,人工肛門を造設しただけで手術を終了した。術後に緊急心臓カテーテル検査にて急性心筋梗塞と診断され,PCIにて治療した。根治的手術は断念し,化学療法を行うこととなり,術後25日目よりcapecitabine(2,000 mg/m2)2週間投与1週間休薬,oxaliplatin(130 mg/m2)day 1投与を行った。腹部CTにて直腸壁の肥厚の改善,周囲リンパ節腫脹の縮小および腫瘍マーカーの減少を認め,1年4か月の間良好なQOLを保ちつつ,病勢コントロールができた。XELOX初期導入時の症例ではあったが,心筋梗塞後のハイリスクな症例に対してXELOX療法は安全に施行でき,良好なコントロールが得られた。