内容紹介
An Elderly Patient with Advanced Breast Cancer Who Responded to Treatment with Letrozole―A Case Report
Summary
An 85-year-old woman was diagnosed as having cancer of the left breast at another hospital in August 2008. As she was judged to be an unsuitable candidate for surgery and had dementia; therefore, she was followed-up without treatment. When the patient visited our hospital in March 2010, a hemorrhagic mass lesion, 5 cm in diameter, was observed in the left breast. We investigated the possibility of metastases and found that the tumor had infiltrated the chest wall, with metastases to the axillary and intrathoracic lymph nodes. Therefore, advanced breast cancer with left-sided pleural effusion and metastases to the pleura and bone was diagnosed. A needle biopsy revealed that the tumor was a ductal carcinoma, which was estrogen receptor(ER)positive, progesterone receptor(PgR)positive, and human epidermal growth factor receptor 2(HER2)(1+). Despite the presence of distant metastases, the patient's systemic condition was reasonably good. Therefore, she was judged to be suitable for some form of treatment, and treatment with letrozole was initiated. Six months after the start of treatment, the primary lesion decreased in size and pleural effusion disappeared. Three years later, the existing lesions have not increased in size and no new lesion has appeared. Endocrine therapy may be effective for the treatment of advanced hormone-sensitive cancers in elderly patients.
要旨
症例は85歳,女性。2008年8月,他院において左乳癌と診断されたが,手術不能と判断。認知症もあるため無治療で経過観察されていた。2010年3月,当院受診。左乳房に易出血性の5 cm径の腫瘤性病変を認めた。転移検索の結果,腫瘍は胸壁に浸潤し,腋窩,内胸リンパ節転移を認め,さらに左胸水,胸膜転移,骨転移を有する進行癌であった。針生検を施行し,乳管癌,ER(+),PgR(+),HER2(1+)と診断された。遠隔転移があるものの患者の全身状態は良好であり,治療の適応はあると考えletrozoleによる治療を開始した。治療はよく奏効し,投与開始後6か月で原発巣は縮小,胸水も消失した。現在,治療開始から3年が経過しているが,病変の増悪,新病変の出現を認めていない。ホルモン感受性がある高齢者進行乳癌には内分泌療法は有効な治療である。
目次
Summary
An 85-year-old woman was diagnosed as having cancer of the left breast at another hospital in August 2008. As she was judged to be an unsuitable candidate for surgery and had dementia; therefore, she was followed-up without treatment. When the patient visited our hospital in March 2010, a hemorrhagic mass lesion, 5 cm in diameter, was observed in the left breast. We investigated the possibility of metastases and found that the tumor had infiltrated the chest wall, with metastases to the axillary and intrathoracic lymph nodes. Therefore, advanced breast cancer with left-sided pleural effusion and metastases to the pleura and bone was diagnosed. A needle biopsy revealed that the tumor was a ductal carcinoma, which was estrogen receptor(ER)positive, progesterone receptor(PgR)positive, and human epidermal growth factor receptor 2(HER2)(1+). Despite the presence of distant metastases, the patient's systemic condition was reasonably good. Therefore, she was judged to be suitable for some form of treatment, and treatment with letrozole was initiated. Six months after the start of treatment, the primary lesion decreased in size and pleural effusion disappeared. Three years later, the existing lesions have not increased in size and no new lesion has appeared. Endocrine therapy may be effective for the treatment of advanced hormone-sensitive cancers in elderly patients.
要旨
症例は85歳,女性。2008年8月,他院において左乳癌と診断されたが,手術不能と判断。認知症もあるため無治療で経過観察されていた。2010年3月,当院受診。左乳房に易出血性の5 cm径の腫瘤性病変を認めた。転移検索の結果,腫瘍は胸壁に浸潤し,腋窩,内胸リンパ節転移を認め,さらに左胸水,胸膜転移,骨転移を有する進行癌であった。針生検を施行し,乳管癌,ER(+),PgR(+),HER2(1+)と診断された。遠隔転移があるものの患者の全身状態は良好であり,治療の適応はあると考えletrozoleによる治療を開始した。治療はよく奏効し,投与開始後6か月で原発巣は縮小,胸水も消失した。現在,治療開始から3年が経過しているが,病変の増悪,新病変の出現を認めていない。ホルモン感受性がある高齢者進行乳癌には内分泌療法は有効な治療である。