内容紹介
Complete Response in a Case of Advanced Oropharyngeal Cancer(T4aN2bM0)Treated with Concomitant Cetuximab and Radiotherapy
Summary
We report favorable results achieved using a combination of cetuximab and radiotherapy to treat an elderly patient with advanced oropharyngeal cancer complicated by cardiovascular disease and renal dysfunction. The case was a 78-year-old man who was referred to our hospital with the chief complaint of pharyngeal pain and swelling of the right side of the neck. The patient was diagnosed with oropharyngeal cancer(T4aN2bM0)based on a cytological diagnosis of Class Ⅴ squamous cell carcinoma and CT findings. Because the patient had a history of hypertension, chronic renal failure, diabetes mellitus, cerebral infarction, angina pectoris, and prostate cancer, we determined that surgical excision and chemoradiotherapy using platinum-based drugs would be difficult. We therefore treated the patient with a combination of cetuximab and radiotherapy. Grade 3 mucous membrane disorder and Grade 2 dermatitis were observed during the course of treatment, but the treatment was completed without any other adverse events. A contrasted CT image taken after the completion of treatment showed that the primary tumor and cervical lymph node metastases had disappeared and the patient thus achieved a complete response. As of 6 months after treatment, there has been no recurrence or metastasis. As shown in this case, combination therapy with cetuximab and radiotherapy can be curative even in elderly patients with advanced oropharyngeal cancer and numerous complicating conditions.
要旨
今回われわれは,高齢者で心疾患,腎機能障害の合併症がある中咽頭癌T4aN2bM0症例にセツキシマブ併用放射線療法を行い,良好な結果を得た症例を経験したので報告する。症例は78歳,男性。咽頭痛と右頸部の腫脹を主訴に当院へ紹介された。細胞診はClass Ⅴ(扁平上皮癌)であり,CTにて中咽頭癌(T4aN2bM0)と診断したが,既往歴として高血圧,慢性腎不全,糖尿病,脳梗塞,狭心症,前立腺癌を認め,手術や白金製剤による化学放射線療法は困難と判断し,セツキシマブ併用放射線療法を行った。経過中,Grade 3の粘膜障害およびGrade 2の皮膚炎を認めたが,他に明らかな有害事象は認めずに治療を完遂した。治療終了後の造影CT検査では原発巣の腫瘍および頸部リンパ節腫脹は消失しており,complete responseと判定した。経過観察期間はまだ浅く6か月であるが,再発,転移は認めていない。セツキシマブ併用放射線療法は,高齢で合併症をもつ進行中咽頭癌患者に対しても有効であると考えられた。
目次
Summary
We report favorable results achieved using a combination of cetuximab and radiotherapy to treat an elderly patient with advanced oropharyngeal cancer complicated by cardiovascular disease and renal dysfunction. The case was a 78-year-old man who was referred to our hospital with the chief complaint of pharyngeal pain and swelling of the right side of the neck. The patient was diagnosed with oropharyngeal cancer(T4aN2bM0)based on a cytological diagnosis of Class Ⅴ squamous cell carcinoma and CT findings. Because the patient had a history of hypertension, chronic renal failure, diabetes mellitus, cerebral infarction, angina pectoris, and prostate cancer, we determined that surgical excision and chemoradiotherapy using platinum-based drugs would be difficult. We therefore treated the patient with a combination of cetuximab and radiotherapy. Grade 3 mucous membrane disorder and Grade 2 dermatitis were observed during the course of treatment, but the treatment was completed without any other adverse events. A contrasted CT image taken after the completion of treatment showed that the primary tumor and cervical lymph node metastases had disappeared and the patient thus achieved a complete response. As of 6 months after treatment, there has been no recurrence or metastasis. As shown in this case, combination therapy with cetuximab and radiotherapy can be curative even in elderly patients with advanced oropharyngeal cancer and numerous complicating conditions.
要旨
今回われわれは,高齢者で心疾患,腎機能障害の合併症がある中咽頭癌T4aN2bM0症例にセツキシマブ併用放射線療法を行い,良好な結果を得た症例を経験したので報告する。症例は78歳,男性。咽頭痛と右頸部の腫脹を主訴に当院へ紹介された。細胞診はClass Ⅴ(扁平上皮癌)であり,CTにて中咽頭癌(T4aN2bM0)と診断したが,既往歴として高血圧,慢性腎不全,糖尿病,脳梗塞,狭心症,前立腺癌を認め,手術や白金製剤による化学放射線療法は困難と判断し,セツキシマブ併用放射線療法を行った。経過中,Grade 3の粘膜障害およびGrade 2の皮膚炎を認めたが,他に明らかな有害事象は認めずに治療を完遂した。治療終了後の造影CT検査では原発巣の腫瘍および頸部リンパ節腫脹は消失しており,complete responseと判定した。経過観察期間はまだ浅く6か月であるが,再発,転移は認めていない。セツキシマブ併用放射線療法は,高齢で合併症をもつ進行中咽頭癌患者に対しても有効であると考えられた。