内容紹介
Six-Year Survival with Recurrent Intrahepatic Cholangiocarcinoma Achieved by Simple S-1 Administration
Summary
We report here a rare case of a patient with recurrent intrahepatic cholangiocarcinoma that was treated with simple S-1 chemotherapy, who is still alive 6 years later. A liver tumor was identified in segments 5 to 6 in a 60-year-old male asymptomatic hepatitis B carrier. The tumor was diagnosed as hepatocellular carcinoma by MRI and CT. However, following its resection by extended posterior segmentectomy of the liver, pathological findings identified it as an intrahepatic cholangiocarcinoma. The surgical margin was cancer-negative. No additional adjuvant chemotherapy was administered because of the patient's impaired renal function. When tumor recurrence was found by MRI 30 months later, an additional liver resection was planned but a laparotomy was eventually performed. This was because intraoperative findings revealed Glissonian sheath invasion with involvement of the umbilical portion. S-1 treatment(100 mg/body/day)was started. Although the dose had to be reduced(mostly 75 mg/body/day)due to hyperbilirubinemia and there were some interruptions in the regimen, in total of 42 g of S-1 was administered. The patient is currently still alive, 6 years after the detection of the tumor recurrence. This represents a rare case in patients with intrahepatic cholangiocarcinoma.
要旨
肝内胆管癌は予後不良な癌として知られ,再発後長期生存の報告は少ない。今回われわれは,S-1単剤で再発後6年の生存をみた症例を経験したので,若干の文献的考察とともに報告する。症例は60歳,男性。HBs抗原陽性にて無症候性キャリアとしてフォロー中,エコーで肝S5-6に腫瘤性病変を指摘された。CT・MRIから肝細胞癌と診断し肝拡大後区域切除術を施行したが,切除断端陰性ながら病理所見は肝内胆管癌だった。腎機能障害などに鑑み術後補助化学療法は行わず経過観察としていたが,術後2年6か月目にMRIで再発が疑われた。追加切除術を試みたが,腫瘍のグリソン浸潤が門脈臍部にまで及んでいたため,試験開腹術に終わった。その後,S-1(100 mg/body/day)を開始したが容易にビリルビン値が上昇するため,減量や休薬などの工夫をしつつも投与を継続した。おおむね75 mg/body/dayの継続で総量42 gが投与できたなか,再発肝内胆管癌ではまれといえる6年という長期生存が得られている。
目次
Summary
We report here a rare case of a patient with recurrent intrahepatic cholangiocarcinoma that was treated with simple S-1 chemotherapy, who is still alive 6 years later. A liver tumor was identified in segments 5 to 6 in a 60-year-old male asymptomatic hepatitis B carrier. The tumor was diagnosed as hepatocellular carcinoma by MRI and CT. However, following its resection by extended posterior segmentectomy of the liver, pathological findings identified it as an intrahepatic cholangiocarcinoma. The surgical margin was cancer-negative. No additional adjuvant chemotherapy was administered because of the patient's impaired renal function. When tumor recurrence was found by MRI 30 months later, an additional liver resection was planned but a laparotomy was eventually performed. This was because intraoperative findings revealed Glissonian sheath invasion with involvement of the umbilical portion. S-1 treatment(100 mg/body/day)was started. Although the dose had to be reduced(mostly 75 mg/body/day)due to hyperbilirubinemia and there were some interruptions in the regimen, in total of 42 g of S-1 was administered. The patient is currently still alive, 6 years after the detection of the tumor recurrence. This represents a rare case in patients with intrahepatic cholangiocarcinoma.
要旨
肝内胆管癌は予後不良な癌として知られ,再発後長期生存の報告は少ない。今回われわれは,S-1単剤で再発後6年の生存をみた症例を経験したので,若干の文献的考察とともに報告する。症例は60歳,男性。HBs抗原陽性にて無症候性キャリアとしてフォロー中,エコーで肝S5-6に腫瘤性病変を指摘された。CT・MRIから肝細胞癌と診断し肝拡大後区域切除術を施行したが,切除断端陰性ながら病理所見は肝内胆管癌だった。腎機能障害などに鑑み術後補助化学療法は行わず経過観察としていたが,術後2年6か月目にMRIで再発が疑われた。追加切除術を試みたが,腫瘍のグリソン浸潤が門脈臍部にまで及んでいたため,試験開腹術に終わった。その後,S-1(100 mg/body/day)を開始したが容易にビリルビン値が上昇するため,減量や休薬などの工夫をしつつも投与を継続した。おおむね75 mg/body/dayの継続で総量42 gが投与できたなか,再発肝内胆管癌ではまれといえる6年という長期生存が得られている。