内容紹介
A Case of Advanced Gastric Cancer with Esophageal Invasion Treated by Neoadjuvant S-1/CDDP Chemotherapy
Summary
A 75-year-old man was found, by endoscopic examination, to have type 2 advanced gastric adenocarcinoma with esophageal invasion in the cardia. Endoscopy and other modalities revealed observable esophageal invasion. To minimize surgical intervention, we treated him with S-1 and cisplatin as neoadjuvant therapy. Treatment was as follows: S-1(80 mg/m2)was administered orally for 3 weeks followed by 2 weeks of rest, and cisplatin(60 mg/m2)was administered by intravenous drip on day 8. Two courses of treatment resulted in marked shrinkage of the primary lesion and improvement of the esophageal invasion. Total gastrectomy with splenectomy, and D2 lymph node dissection were performed with an adequately long proximal margin, without thoracotomy. Pathological efficacy was Grade 2. At present, 1 year after the operation, the patient presents no evidence of a recurrence. We concluded that through neoadjuvant chemotherapy for advanced gastric cancer with esophageal invasion, thoracotomy could be avoided, thereby reducing risks associated with surgery.
要旨
症例は75歳,男性。食道浸潤を伴った胃噴門部癌に対して,開胸手術を避けて手術侵襲を低減させることを目標にS-1とCDDPによる術前化学療法を行った。S-1は80 mg/m2を21日間経口投与し14日間休薬した。CDDPは60 mg/m2をday 8に投与した。2コース施行後,内視鏡所見上で腫瘍は著明に縮小して食道浸潤は消失したため,経腹操作のみで胃全摘,脾臓合併切除術を施行できた。摘出標本の病理組織学的効果判定はGrade 2であった。術後1年無再発生存中である。食道浸潤胃癌に対する術前化学療法により,開胸を回避して手術侵襲の大きな軽減が図れる可能性があると考えられた。
目次
Summary
A 75-year-old man was found, by endoscopic examination, to have type 2 advanced gastric adenocarcinoma with esophageal invasion in the cardia. Endoscopy and other modalities revealed observable esophageal invasion. To minimize surgical intervention, we treated him with S-1 and cisplatin as neoadjuvant therapy. Treatment was as follows: S-1(80 mg/m2)was administered orally for 3 weeks followed by 2 weeks of rest, and cisplatin(60 mg/m2)was administered by intravenous drip on day 8. Two courses of treatment resulted in marked shrinkage of the primary lesion and improvement of the esophageal invasion. Total gastrectomy with splenectomy, and D2 lymph node dissection were performed with an adequately long proximal margin, without thoracotomy. Pathological efficacy was Grade 2. At present, 1 year after the operation, the patient presents no evidence of a recurrence. We concluded that through neoadjuvant chemotherapy for advanced gastric cancer with esophageal invasion, thoracotomy could be avoided, thereby reducing risks associated with surgery.
要旨
症例は75歳,男性。食道浸潤を伴った胃噴門部癌に対して,開胸手術を避けて手術侵襲を低減させることを目標にS-1とCDDPによる術前化学療法を行った。S-1は80 mg/m2を21日間経口投与し14日間休薬した。CDDPは60 mg/m2をday 8に投与した。2コース施行後,内視鏡所見上で腫瘍は著明に縮小して食道浸潤は消失したため,経腹操作のみで胃全摘,脾臓合併切除術を施行できた。摘出標本の病理組織学的効果判定はGrade 2であった。術後1年無再発生存中である。食道浸潤胃癌に対する術前化学療法により,開胸を回避して手術侵襲の大きな軽減が図れる可能性があると考えられた。