内容紹介
Complete Resection of Liver Metastases of Colorectal Cancer after High Efficacy Bevacizumab, S-1, and CPT-11 Combination Chemotherapy
Summary
We describe a case of liver metastasis of colorectal cancer that became resectable after bevacizumab(Bmab), CPT-11, and S-1 ie Bmab+IRIS combination chemotherapy. A 65-year-old man experienced repeated constipation and diarrhea in August of 2013. Colonoscopy was conducted by a local doctor, and a tumor(diagnosed as adenocarcinoma tub1 by biopsy)was found in the upper rectum. Computed tomography performed at our institution detected synchronous liver metastasis. On September 9, laparoscopic rectal anterior resection was performed to prevent metastasis to the ileus, and on October 9, the patient began receiving Bmab+IRIS combination chemotherapy. Before chemotherapy, 3 metastases with a maximum diameter of 7 cm diameter)were observed in the right lobe of the liver. After 4 courses of chemotherapy, their maximum diameter was 3 cm, which allowed resection. Ultimately, the metastases were completely resected. Conversion of nonoptimal resection cases of liver metastases to optimal cases by using Bmab+IRIS chemotherapy is extremely rare. We suggest that Bmab+IRIS chemotherapy could be an option for conversion of nonoptimal liver resection cases to optimal cases. We report this rare case and discuss the implications of adjuvant chemotherapy for this patient.
要旨
bevacizumab(Bmab),S-1,CPT-11による3剤併用療法(Bmab+IRIS療法)施行により,肝転移が縮小し完全切除が可能となった進行大腸癌を経験した。症例は65歳,男性。2013年8月に便秘・下痢を繰り返し近医受診。下部消化管内視鏡検査にて直腸(Rs)に全周性の腫瘍が認められたため(生検でadenocarcinoma,tub1),治療目的に当院紹介。造影CT検査で同時性多発肝転移を認めた。肝右葉に3か所の転移巣を認め,最大径7 cmであったため切除は非最適と考えられた。直腸癌に対して9月9日に直腸前方切除術(D3郭清)を施行。10月9日より,多発肝転移に対しBmab+IRIS療法を開始。4コースの化学療法により,すべての肝転移巣が縮小し最大のものは3 cmまで縮小したため,肝転移切除術が施行され根治切除に至った。肝切除非最適症例がBmab+IRIS療法施行により手術可能となり,完全切除に至れた報告は過去にない。切除非最適因子をもつ大腸癌肝転移症例に対するBmab+IRIS療法施行は,肝転移巣完全切除に至るための一選択肢となり得ることが示唆された。本症例に対する術後化学療法の適応に関する考察とともに,症例を報告する。
目次
Summary
We describe a case of liver metastasis of colorectal cancer that became resectable after bevacizumab(Bmab), CPT-11, and S-1 ie Bmab+IRIS combination chemotherapy. A 65-year-old man experienced repeated constipation and diarrhea in August of 2013. Colonoscopy was conducted by a local doctor, and a tumor(diagnosed as adenocarcinoma tub1 by biopsy)was found in the upper rectum. Computed tomography performed at our institution detected synchronous liver metastasis. On September 9, laparoscopic rectal anterior resection was performed to prevent metastasis to the ileus, and on October 9, the patient began receiving Bmab+IRIS combination chemotherapy. Before chemotherapy, 3 metastases with a maximum diameter of 7 cm diameter)were observed in the right lobe of the liver. After 4 courses of chemotherapy, their maximum diameter was 3 cm, which allowed resection. Ultimately, the metastases were completely resected. Conversion of nonoptimal resection cases of liver metastases to optimal cases by using Bmab+IRIS chemotherapy is extremely rare. We suggest that Bmab+IRIS chemotherapy could be an option for conversion of nonoptimal liver resection cases to optimal cases. We report this rare case and discuss the implications of adjuvant chemotherapy for this patient.
要旨
bevacizumab(Bmab),S-1,CPT-11による3剤併用療法(Bmab+IRIS療法)施行により,肝転移が縮小し完全切除が可能となった進行大腸癌を経験した。症例は65歳,男性。2013年8月に便秘・下痢を繰り返し近医受診。下部消化管内視鏡検査にて直腸(Rs)に全周性の腫瘍が認められたため(生検でadenocarcinoma,tub1),治療目的に当院紹介。造影CT検査で同時性多発肝転移を認めた。肝右葉に3か所の転移巣を認め,最大径7 cmであったため切除は非最適と考えられた。直腸癌に対して9月9日に直腸前方切除術(D3郭清)を施行。10月9日より,多発肝転移に対しBmab+IRIS療法を開始。4コースの化学療法により,すべての肝転移巣が縮小し最大のものは3 cmまで縮小したため,肝転移切除術が施行され根治切除に至った。肝切除非最適症例がBmab+IRIS療法施行により手術可能となり,完全切除に至れた報告は過去にない。切除非最適因子をもつ大腸癌肝転移症例に対するBmab+IRIS療法施行は,肝転移巣完全切除に至るための一選択肢となり得ることが示唆された。本症例に対する術後化学療法の適応に関する考察とともに,症例を報告する。