内容紹介
A Case of Locally Advanced Rectal Cancer Successfully Treated by Conversion Surgery after Multidisciplinary Treatment
Summary
A 70-year-old woman who complained of abdominal pain and a prolapsed tumor from the anus was diagnosed with an intestinal obstruction resulting from anal canal cancer. Computed tomography(CT)and magnetic resonance imaging revealed a huge tumor(11×5×12 cm)invading the vagina and levator ani muscle. Enlarged inguinal lymph nodes on both sides indicated metastasis. The clinical stage was T4b(vagina, levator ani muscle, and pudenda)N0H0M1a(LYM), stageⅣ(Japanese Classification of Colorectal Carcinoma: 8th edition). As curative resection was not possible, a transvers colostomy was performed to relieve the intestinal obstruction. This was followed by chemoradiotherapy(45 Gy/1.8 Gy×25; TS-1, 80 mg/body for 2 weeks and a 1-week interval, for 2 courses)and up to 10 courses of Bev+mFOLFOX6 continuously. After this regimen, there was a remarkable reduction in tumor size. Positron emission tomography-CT revealed no FDG uptake in the primary rectal site or inguinal lymph nodes, but a maximum standardized uptake value(SUVmax)of 6.3 was detected in the vagina. Six weeks after chemotherapy, the patient underwent a pelvic exenteration including resection of the vagina, bladder, and pudenda. The pathological stage was yp T4b(vagina)N0H0M0, stageⅡ. Curative resection was performed, and the patient had a Grade 2 pathological response after chemoradiotherapy.
要旨
症例は70歳,女性。主訴は肛門からの腫瘍の脱出と腹痛。肛門管癌(低分化腺癌)によるイレウスと診断された。胸腹部CT・MRIでは,膣壁および肛門挙筋に広範に浸潤する11×5×12 cmと巨大な腫瘍を認め,両側鼠径リンパ節は腫大し転移が示唆された。直腸(Rb)癌,cT4b(膣・外陰部・肛門挙筋),N0H0P0M1a(LYM),stageⅣ(大腸癌取扱い規約第8版)と診断,根治切除は不可能と判断した。イレウス解除目的で横行結腸双孔式人工肛門を作製の後,術前化学放射線療法(45 Gy/1.8 Gy×25,TS-1 80 mg/body: 2週投与1週休薬,計2コース),続いてBev+mFOLFOX6 10コース施行した。腫瘍は著明に縮小し,PET-CT検査では原発巣・鼠径リンパ節への集積は消失,膣のみにSUVmax 6.3の異常集積を認めた。化学療法終了6週後に膣・膀胱・外陰部を合併切除する骨盤内臓全摘術を施行した。結果,進行度ypT4b(膣),N0H0P0M0,stageⅡで治癒切除となった。術前治療の効果はGrade 2であった。
目次
Summary
A 70-year-old woman who complained of abdominal pain and a prolapsed tumor from the anus was diagnosed with an intestinal obstruction resulting from anal canal cancer. Computed tomography(CT)and magnetic resonance imaging revealed a huge tumor(11×5×12 cm)invading the vagina and levator ani muscle. Enlarged inguinal lymph nodes on both sides indicated metastasis. The clinical stage was T4b(vagina, levator ani muscle, and pudenda)N0H0M1a(LYM), stageⅣ(Japanese Classification of Colorectal Carcinoma: 8th edition). As curative resection was not possible, a transvers colostomy was performed to relieve the intestinal obstruction. This was followed by chemoradiotherapy(45 Gy/1.8 Gy×25; TS-1, 80 mg/body for 2 weeks and a 1-week interval, for 2 courses)and up to 10 courses of Bev+mFOLFOX6 continuously. After this regimen, there was a remarkable reduction in tumor size. Positron emission tomography-CT revealed no FDG uptake in the primary rectal site or inguinal lymph nodes, but a maximum standardized uptake value(SUVmax)of 6.3 was detected in the vagina. Six weeks after chemotherapy, the patient underwent a pelvic exenteration including resection of the vagina, bladder, and pudenda. The pathological stage was yp T4b(vagina)N0H0M0, stageⅡ. Curative resection was performed, and the patient had a Grade 2 pathological response after chemoradiotherapy.
要旨
症例は70歳,女性。主訴は肛門からの腫瘍の脱出と腹痛。肛門管癌(低分化腺癌)によるイレウスと診断された。胸腹部CT・MRIでは,膣壁および肛門挙筋に広範に浸潤する11×5×12 cmと巨大な腫瘍を認め,両側鼠径リンパ節は腫大し転移が示唆された。直腸(Rb)癌,cT4b(膣・外陰部・肛門挙筋),N0H0P0M1a(LYM),stageⅣ(大腸癌取扱い規約第8版)と診断,根治切除は不可能と判断した。イレウス解除目的で横行結腸双孔式人工肛門を作製の後,術前化学放射線療法(45 Gy/1.8 Gy×25,TS-1 80 mg/body: 2週投与1週休薬,計2コース),続いてBev+mFOLFOX6 10コース施行した。腫瘍は著明に縮小し,PET-CT検査では原発巣・鼠径リンパ節への集積は消失,膣のみにSUVmax 6.3の異常集積を認めた。化学療法終了6週後に膣・膀胱・外陰部を合併切除する骨盤内臓全摘術を施行した。結果,進行度ypT4b(膣),N0H0P0M0,stageⅡで治癒切除となった。術前治療の効果はGrade 2であった。