内容紹介
A Case of Radical Resection of Rectal Cancer with Multiple Liver and Lung Metastases after Preoperative Chemotherapy
Summary
We report a case of radical resection of rectal cancer with multiple liver and lung metastases after preoperative chemotherapy. A 54-year-old woman presented with abdominal pain and loss of body weight due to rectal cancer with multiple liver and lung metastases. Therefore, the patient received 14 courses of bevacizumab+mFOLFOX6, and 7 courses of panitumumab+FOLFIRI. After the chemotherapy, the size of the distant metastases reduced by 62% on computed tomography, according to RECIST. Due to the reduction in size, a conversion surgery was attempted. First, an abdominal operation with laparoscopy was performed, and 2 months later an operation to resect the lung metastases via thoracoscopy was performed. Currently, 3 months after surgery, the patient is alive, without recurrence.
要旨
症例は54歳,女性。体重減少と腹部腫瘤を主訴に当院紹介受診。精査の結果,転移性肝・肺腫瘍を伴う直腸(RS)癌,tub2,cT4a(SE),N0M1b(H3,PUL1),cStageⅣの診断。残肝率の問題から切除不能と判断し,全身化学療法を選択。一次治療としてB-mab+mFOLFOX6を14コース施行。末梢神経障害(Grade 2)のため,二次治療として初診9か月後よりP-mab+FOLFIRIを7コース施行。効果判定はPR,肝・肺の遠隔転移巣も含め切除可能と判断し手術を選択。経皮経肝門脈塞栓術を施行した後に腹腔鏡下肝切除術と開腹低位前方切除術,その約2か月後に胸腔鏡下肺切除術を施行しR0手術を得られた。現在,術後化学療法を行わずにいるが,再発を認めていない。K-ras野生型切除不能進行大腸癌に対して,抗EGFR抗体使用のタイミングを逸しないことが重要で,conversion surgeryの可能性を念頭に置いて診療する必要がある。
目次
Summary
We report a case of radical resection of rectal cancer with multiple liver and lung metastases after preoperative chemotherapy. A 54-year-old woman presented with abdominal pain and loss of body weight due to rectal cancer with multiple liver and lung metastases. Therefore, the patient received 14 courses of bevacizumab+mFOLFOX6, and 7 courses of panitumumab+FOLFIRI. After the chemotherapy, the size of the distant metastases reduced by 62% on computed tomography, according to RECIST. Due to the reduction in size, a conversion surgery was attempted. First, an abdominal operation with laparoscopy was performed, and 2 months later an operation to resect the lung metastases via thoracoscopy was performed. Currently, 3 months after surgery, the patient is alive, without recurrence.
要旨
症例は54歳,女性。体重減少と腹部腫瘤を主訴に当院紹介受診。精査の結果,転移性肝・肺腫瘍を伴う直腸(RS)癌,tub2,cT4a(SE),N0M1b(H3,PUL1),cStageⅣの診断。残肝率の問題から切除不能と判断し,全身化学療法を選択。一次治療としてB-mab+mFOLFOX6を14コース施行。末梢神経障害(Grade 2)のため,二次治療として初診9か月後よりP-mab+FOLFIRIを7コース施行。効果判定はPR,肝・肺の遠隔転移巣も含め切除可能と判断し手術を選択。経皮経肝門脈塞栓術を施行した後に腹腔鏡下肝切除術と開腹低位前方切除術,その約2か月後に胸腔鏡下肺切除術を施行しR0手術を得られた。現在,術後化学療法を行わずにいるが,再発を認めていない。K-ras野生型切除不能進行大腸癌に対して,抗EGFR抗体使用のタイミングを逸しないことが重要で,conversion surgeryの可能性を念頭に置いて診療する必要がある。