内容紹介
A Case of Advanced Pancreas Cancer Successfully Treated by Using Combined Modality Therapy
Summary
A 62-year-old woman visited a nearby hospital with chief complaints of diarrhea and weight loss. A computed tomography(CT)scan showed a hypovascular tumor approximately 2 cm in diameter in the pancreatic uncus, and the patient was referred to our department for thorough examination and treatment. The patient was diagnosed with cT4(A)N0M0, cStageⅣa cancer of the pancreatic uncus. The treatment consisted of 3 weeks of gemcitabine and 1 week of drug withdrawal; after completion of 4 courses, concomitant administration of S-1(ie GS therapy)was initiated. The tumor gradually shrank, and it was not observed on a CT scan 1 year and 8 months later. Although no obvious distant metastasis was observed, a low density area around the superior mesenteric artery still remained. Possibility of viable tumor could not be completely ruled out; therefore, a pancreaticoduodenectomy was scheduled. However, because sclerosis around the superior mesenteric artery was quite severe, bled easily, and was difficult to separate, we decided that excision was impossible and resumed the GS therapy. The primary lung cancer that developed subsequently was resected, and the GS therapy was continued. The tumor in the pancreatic uncus was resected after growth was observed 3 years and 9 months after the initiation of chemotherapy. The patient is currently receiving chemotherapy as an outpatient.
要旨 症例は62歳,女性。下痢と体重減少を主訴に近医を受診した。CTで膵鉤部に径2 cm大の乏血性腫瘍を認め,当科に紹介された。膵鉤部癌cT4(A)N0M0,cStageⅣaの診断で,gemcitabineを3週投与1週休薬で開始した。4コース終了後,S-1の併用(GS療法)を開始した。徐々に腫瘍は縮小し,1年8か月後のCTで上腸間膜動脈周囲の軟部陰影が残存するのみで,膵内の腫瘤を同定し得なくなった。遠隔転移を認めず,膵頭十二指腸切除術を予定した。上腸間膜動脈周囲神経叢の線維化と肥厚が非常に強く,切除不能と判断しGS療法を再開した。その後,罹患した原発性肺癌を切除し,GS療法を継続した。化学療法開始3年9か月のCTで膵鉤部の腫瘍が再増大したため切除を行った。治療開始5年後の現在も化学療法中である。
目次
Summary
A 62-year-old woman visited a nearby hospital with chief complaints of diarrhea and weight loss. A computed tomography(CT)scan showed a hypovascular tumor approximately 2 cm in diameter in the pancreatic uncus, and the patient was referred to our department for thorough examination and treatment. The patient was diagnosed with cT4(A)N0M0, cStageⅣa cancer of the pancreatic uncus. The treatment consisted of 3 weeks of gemcitabine and 1 week of drug withdrawal; after completion of 4 courses, concomitant administration of S-1(ie GS therapy)was initiated. The tumor gradually shrank, and it was not observed on a CT scan 1 year and 8 months later. Although no obvious distant metastasis was observed, a low density area around the superior mesenteric artery still remained. Possibility of viable tumor could not be completely ruled out; therefore, a pancreaticoduodenectomy was scheduled. However, because sclerosis around the superior mesenteric artery was quite severe, bled easily, and was difficult to separate, we decided that excision was impossible and resumed the GS therapy. The primary lung cancer that developed subsequently was resected, and the GS therapy was continued. The tumor in the pancreatic uncus was resected after growth was observed 3 years and 9 months after the initiation of chemotherapy. The patient is currently receiving chemotherapy as an outpatient.
要旨 症例は62歳,女性。下痢と体重減少を主訴に近医を受診した。CTで膵鉤部に径2 cm大の乏血性腫瘍を認め,当科に紹介された。膵鉤部癌cT4(A)N0M0,cStageⅣaの診断で,gemcitabineを3週投与1週休薬で開始した。4コース終了後,S-1の併用(GS療法)を開始した。徐々に腫瘍は縮小し,1年8か月後のCTで上腸間膜動脈周囲の軟部陰影が残存するのみで,膵内の腫瘤を同定し得なくなった。遠隔転移を認めず,膵頭十二指腸切除術を予定した。上腸間膜動脈周囲神経叢の線維化と肥厚が非常に強く,切除不能と判断しGS療法を再開した。その後,罹患した原発性肺癌を切除し,GS療法を継続した。化学療法開始3年9か月のCTで膵鉤部の腫瘍が再増大したため切除を行った。治療開始5年後の現在も化学療法中である。