内容紹介
A Case of Advanced Sigmoid Colon Cancer with Metastases in the Liver and the Paraaortic Lymph Nodes Successfully Treated with 5-FU/l-LV and FOLFOX4 Followed by S-1 Leading to Long-Term Complete Response
Summary
The patient was a 70-year-old woman with sigmoid colon cancer and metastases in the liver and the paraaortic lymph nodes. We performed sigmoidectomy along with lymph node dissection. The solitary hepatic metastasis was 3 cm in diameter; however, hepatectomy was not performed because metastases in the paraaortic lymph nodes persisted. The serum carcinoembryonic antigen(CEA)level was above 200 ng/mL, both preoperatively and postoperatively. After surgery, chemotherapy was initiated. Initially, weekly 5-fluorouracil and l-Leucovorin(5-FU/l-LV)therapy was administered 4 times. Subsequently, 5-FU/folinic acid plus oxaliplatin(FOLFOX4)therapy was administered 12 times every 2 weeks. Thereafter, S-1 therapy(orally, 40 mg twice a day, 28 days, followed by 14 days of rest)was initiated. After 3 months of chemotherapy, serum CEA levels decreased rapidly to within the normal limit. Paraaortic lymph node metastases and the hepatic metastasis disappeared after 3 months and 11 months, respectively. S-1 therapy was continued for over 7 years. Currently, it has been over 1 year since the discontinuation of S-1 therapy, and complete response has been maintained for over 9 years since the surgery.
要旨
症例は70歳,女性。肝転移と傍大動脈リンパ節転移を伴うS状結腸癌である。S状結腸切除術,リンパ節郭清術を施行した。肝転移は単発で直径3 cmであったが,傍大動脈リンパ節転移が遺残したため肝切除は行わなかった。血清CEA値は術前も術後もほとんど変わらず200 ng/mL以上であった。術後の化学療法として,まずweekly 5-FU/l-LV療法を4週行い,続いてFOLFOX4療法を2週間ごとに12回施行した。その後はS-1の内服を28日間投薬14日間休薬で行った。血清CEA値は化学療法を開始後急速に低下し,3か月で正常値に復した。リンパ節転移と肝転移はそれぞれ,3か月後,11か月後にCT上消失した。S-1の内服は7年以上継続し,その後中止して1年以上経過しているが,術後9年以上経過してCRが続いている。
目次
Summary
The patient was a 70-year-old woman with sigmoid colon cancer and metastases in the liver and the paraaortic lymph nodes. We performed sigmoidectomy along with lymph node dissection. The solitary hepatic metastasis was 3 cm in diameter; however, hepatectomy was not performed because metastases in the paraaortic lymph nodes persisted. The serum carcinoembryonic antigen(CEA)level was above 200 ng/mL, both preoperatively and postoperatively. After surgery, chemotherapy was initiated. Initially, weekly 5-fluorouracil and l-Leucovorin(5-FU/l-LV)therapy was administered 4 times. Subsequently, 5-FU/folinic acid plus oxaliplatin(FOLFOX4)therapy was administered 12 times every 2 weeks. Thereafter, S-1 therapy(orally, 40 mg twice a day, 28 days, followed by 14 days of rest)was initiated. After 3 months of chemotherapy, serum CEA levels decreased rapidly to within the normal limit. Paraaortic lymph node metastases and the hepatic metastasis disappeared after 3 months and 11 months, respectively. S-1 therapy was continued for over 7 years. Currently, it has been over 1 year since the discontinuation of S-1 therapy, and complete response has been maintained for over 9 years since the surgery.
要旨
症例は70歳,女性。肝転移と傍大動脈リンパ節転移を伴うS状結腸癌である。S状結腸切除術,リンパ節郭清術を施行した。肝転移は単発で直径3 cmであったが,傍大動脈リンパ節転移が遺残したため肝切除は行わなかった。血清CEA値は術前も術後もほとんど変わらず200 ng/mL以上であった。術後の化学療法として,まずweekly 5-FU/l-LV療法を4週行い,続いてFOLFOX4療法を2週間ごとに12回施行した。その後はS-1の内服を28日間投薬14日間休薬で行った。血清CEA値は化学療法を開始後急速に低下し,3か月で正常値に復した。リンパ節転移と肝転移はそれぞれ,3か月後,11か月後にCT上消失した。S-1の内服は7年以上継続し,その後中止して1年以上経過しているが,術後9年以上経過してCRが続いている。