内容紹介
A Case of Recurrent Non-Small Cell Lung Cancer Successfully Treated with Multiple Modality Therapies Including S-1 Monotherapy as Fifth-Line Chemotherapy
Summary
An 80-year-old man with no complaint was referred to our department because of high serum CEA level. He was diagnosed as non-small cell lung cancer(adenocarcinoma)of the left lower lobe(c-T2aN0M0, stageⅠB), and therefore the left lower lobectomy with lymph node dissection was performed. Pathological staging was p-T2aN1(#10)M0, stageⅡA, and EGFR mutation was negative. Adjuvant chemotherapy with UFT was started, but multiple hilar and mediastinal lymph nodes metastases soon appeared. Carboplatin(CBDCA)+paclitaxel(PTX), erlotinib, and docetaxel(DOC)were attempted after that, but the lymph nodes increased in size and the CEA level was up to 159.8 ng/mL. At about the same time, brain and pulmonary metastases were recognized. After radiation for the chest lymph nodes and stereotactic radiosurgery(SRS)for the brain metastasis, oral S-1 monotherapy was introduced. Soon after, the lymph nodes shrinked and the CEA level decreased. Also, the pulmonary metastasis disappeared. Although a right supraclavicular lymph node metastasis was resected during the clinical course, the S-1 monotherapy has been continued with no serious adverse event. He is well(PS 0)without recurrent lesion, and his serum CEA level is within the normal limit.
要旨
症例は80歳,男性。血清CEA高値を契機に非小細胞肺癌(腺癌),c-T2aN0M0,stageⅠBと診断し左下葉切除,リンパ節郭清を行った。術後病理診断で#10リンパ節転移が認められ,病理病期はp-T2aN1M0 stageⅡAであった。またEGFR遺伝子変異は陰性であった。プラチナベース2剤併用の術後補助化学療法を勧めたが同意を得られず,UFTで術後補助化学療法を行った。その後,肺門・縦隔リンパ節転移,脳転移,肺転移が出現した。化学療法はUFTの後,carboplatin(CBDCA)+paclitaxel(PTX),erlotinib,docetaxel(DOC)が行われ,いずれも効果はprogressive disease(PD)であった。胸部リンパ節照射と定位脳照射の後,五次化学療法としてS-1単剤が導入され,リンパ節の縮小,肺転移の消失,CEAの低下が認められた。経過中に単発で出現した右鎖骨上リンパ節転移巣切除の後もS-1単剤療法は継続されているが,術後5年以上経過した現在,CEAは基準値未満となり新たな転移巣の出現は認められず,performance status(PS) 0を保ったまま外来通院中である。経口剤であるS-1は既治療非小細胞肺癌治療において,quality of life(QOL)を保ちながら治療効果も十分期待できる薬剤である。
目次
Summary
An 80-year-old man with no complaint was referred to our department because of high serum CEA level. He was diagnosed as non-small cell lung cancer(adenocarcinoma)of the left lower lobe(c-T2aN0M0, stageⅠB), and therefore the left lower lobectomy with lymph node dissection was performed. Pathological staging was p-T2aN1(#10)M0, stageⅡA, and EGFR mutation was negative. Adjuvant chemotherapy with UFT was started, but multiple hilar and mediastinal lymph nodes metastases soon appeared. Carboplatin(CBDCA)+paclitaxel(PTX), erlotinib, and docetaxel(DOC)were attempted after that, but the lymph nodes increased in size and the CEA level was up to 159.8 ng/mL. At about the same time, brain and pulmonary metastases were recognized. After radiation for the chest lymph nodes and stereotactic radiosurgery(SRS)for the brain metastasis, oral S-1 monotherapy was introduced. Soon after, the lymph nodes shrinked and the CEA level decreased. Also, the pulmonary metastasis disappeared. Although a right supraclavicular lymph node metastasis was resected during the clinical course, the S-1 monotherapy has been continued with no serious adverse event. He is well(PS 0)without recurrent lesion, and his serum CEA level is within the normal limit.
要旨
症例は80歳,男性。血清CEA高値を契機に非小細胞肺癌(腺癌),c-T2aN0M0,stageⅠBと診断し左下葉切除,リンパ節郭清を行った。術後病理診断で#10リンパ節転移が認められ,病理病期はp-T2aN1M0 stageⅡAであった。またEGFR遺伝子変異は陰性であった。プラチナベース2剤併用の術後補助化学療法を勧めたが同意を得られず,UFTで術後補助化学療法を行った。その後,肺門・縦隔リンパ節転移,脳転移,肺転移が出現した。化学療法はUFTの後,carboplatin(CBDCA)+paclitaxel(PTX),erlotinib,docetaxel(DOC)が行われ,いずれも効果はprogressive disease(PD)であった。胸部リンパ節照射と定位脳照射の後,五次化学療法としてS-1単剤が導入され,リンパ節の縮小,肺転移の消失,CEAの低下が認められた。経過中に単発で出現した右鎖骨上リンパ節転移巣切除の後もS-1単剤療法は継続されているが,術後5年以上経過した現在,CEAは基準値未満となり新たな転移巣の出現は認められず,performance status(PS) 0を保ったまま外来通院中である。経口剤であるS-1は既治療非小細胞肺癌治療において,quality of life(QOL)を保ちながら治療効果も十分期待できる薬剤である。