内容紹介
A Case of Inoperable Advanced Bile Duct Cancer Treated Effectively with Combined Chemotherapy of Gemcitabine and S-1
Summary
The patient was a 63-year-old male. He was admitted to our department due to obstructive jaundice and acute renal failure, and was diagnosed with a lower bile duct cancer. As a result of a stent placement into the bile duct and hemodialysis, jaundice and renal failure improved. As scattered metastases were recognized on the superior surface of both hepatic lobes in intraoperative findings, only a portoenterostomy was performed. After that, 1,000 mg/m2 of gemcitabine(day 1)and 60 mg/m2/day of S-1(days 1-7)were administered repeatedly every other week as a course. One year and four months after the start of chemotherapy, radiation therapy of 40 Gy was performed at the site considered to be the remaining primary tumor according to the PET-CT findings. While chemotherapy was continued without change thereafter, the time passed with no visualization of lesions by CT. Two years and five months after the start of chemotherapy, duodenal stenosis and a metastasis in the liver occurred, resulting thereafter in aggravated conditions and death. The entire course lasted two years and eight months. We considered that combined therapy of gemcitabine and S-1 would be a useful option in chemotherapy for biliary tract cancer.
要旨
症例は63歳,男性。2007年10月閉塞性黄疸,急性腎不全のため入院。下部胆管癌と診断し,胆管ステント留置,血液透析にて黄疸,腎不全は改善した。開腹所見にて肝両葉漿膜面に散在する転移を認め,肝門部空腸吻合術のみ施行。その後gemcitabine(GEM),S-1併用による全身化学療法を開始。GEM 1,000 mg/m2(day 1),S-1 60 mg/m2/day(day 1～7),2週1コースの投与を繰り返した。その後のCTでは原発巣,肝転移巣ともに描出されないまま経過した。化学療法開始1年4か月経過後,PET-CTにて肝門部に集積を認め,原発巣の残存と考え,同部に40 Gyの放射線療法を施行。化学療法は変更なく継続したが,その後もCTでは病変は描出されないままであった。化学療法開始2年5か月経過後,原発巣の増大による十二指腸狭窄を生じ,肝左葉内に転移巣の出現あり。その後癌性腹膜炎,肝転移巣の増大による肝不全症状の出現を認め,全経過2年8か月で死亡した。本症例の経験より,切除不能胆管癌に対するGEM,S-1併用療法は,有用な選択肢となり得ると考えた。
目次
Summary
The patient was a 63-year-old male. He was admitted to our department due to obstructive jaundice and acute renal failure, and was diagnosed with a lower bile duct cancer. As a result of a stent placement into the bile duct and hemodialysis, jaundice and renal failure improved. As scattered metastases were recognized on the superior surface of both hepatic lobes in intraoperative findings, only a portoenterostomy was performed. After that, 1,000 mg/m2 of gemcitabine(day 1)and 60 mg/m2/day of S-1(days 1-7)were administered repeatedly every other week as a course. One year and four months after the start of chemotherapy, radiation therapy of 40 Gy was performed at the site considered to be the remaining primary tumor according to the PET-CT findings. While chemotherapy was continued without change thereafter, the time passed with no visualization of lesions by CT. Two years and five months after the start of chemotherapy, duodenal stenosis and a metastasis in the liver occurred, resulting thereafter in aggravated conditions and death. The entire course lasted two years and eight months. We considered that combined therapy of gemcitabine and S-1 would be a useful option in chemotherapy for biliary tract cancer.
要旨
症例は63歳,男性。2007年10月閉塞性黄疸,急性腎不全のため入院。下部胆管癌と診断し,胆管ステント留置,血液透析にて黄疸,腎不全は改善した。開腹所見にて肝両葉漿膜面に散在する転移を認め,肝門部空腸吻合術のみ施行。その後gemcitabine(GEM),S-1併用による全身化学療法を開始。GEM 1,000 mg/m2(day 1),S-1 60 mg/m2/day(day 1～7),2週1コースの投与を繰り返した。その後のCTでは原発巣,肝転移巣ともに描出されないまま経過した。化学療法開始1年4か月経過後,PET-CTにて肝門部に集積を認め,原発巣の残存と考え,同部に40 Gyの放射線療法を施行。化学療法は変更なく継続したが,その後もCTでは病変は描出されないままであった。化学療法開始2年5か月経過後,原発巣の増大による十二指腸狭窄を生じ,肝左葉内に転移巣の出現あり。その後癌性腹膜炎,肝転移巣の増大による肝不全症状の出現を認め,全経過2年8か月で死亡した。本症例の経験より,切除不能胆管癌に対するGEM,S-1併用療法は,有用な選択肢となり得ると考えた。