内容紹介
A Case of Multiple Tumor Neurosurgery for Brain Metastasis of Colorectal Cancer
Summary
We report a patient with brain metastasis of rectal cancer who underwent metastatic tumor resection 3 times. In March 2012, a 76-years-old man, diagnosed with Stage Ⅲa rectal cancer, underwent Hartmann's operation. The lung metastasis was confirmed in July and November 2013, surgical resection for pulmonary metastasis was performed 2 times. In January 2016, he had difficulty of speaking, and isolated brain tumor was found. We performed surgical resection of brain metastasis in February 2016. In March and July 2016, the gamma knife radiosurgery was performed for other brain metastasis. In July 2016, he occurred nausea, headache and right identity hemi-blindness. Two new brain tumors were revealed. We performed surgical resection again. Three months after second brain surgery, he had dysarthria and a solitary brain tumor was confirmed. We performed third neurosurgical resection. All tumors of brain were found to be metastasis from rectal cancer in histological study. Currently, 16 months have passed since the first diagnosis of brain metastasis of this patient, and the quality of life was good relatively. The prognosis of the patients with brain metastasis is poor generally. However, this case suggested that multiple surgical resection of brain metastasis could improve prognosis and quality of life of patients. Accumulation of further cases is needed.
要旨
症例は76歳,男性。2012年3月にStage Ⅲaの直腸癌に対しHartmann手術が施行された。2013年7月,11月に肺転移を認め,いずれも肺部分切除術を施行された。2016年1月にろれつ困難を認め,精査で孤立性脳腫瘍を指摘されたため2月に開頭腫瘍摘出術を施行した 。3月 ,7月に後頭葉の新たな病変に対しガンマナイフ療法を施行した 。7月に嘔気・頭痛・右同名性半盲を認め,精査したところ新たな脳腫瘍を指摘され,開頭腫瘍摘出術を施行した。9月に構語障害を発症し,孤立性脳腫瘍を認めたため開頭腫瘍摘出術を施行した。3回の脳腫瘍の病理診断では,いずれも直腸癌の脳転移であった。自験例では3回の腫瘍摘出,2回の放射線療法を行ったが,脳転移診断時より16か月の生存が得られており,QOLも比較的保たれていた。大腸癌原発の転移性脳腫瘍に対し複数回の手術を行うことは,予後およびQOLを改善し得る可能性が示唆された。
目次
Summary
We report a patient with brain metastasis of rectal cancer who underwent metastatic tumor resection 3 times. In March 2012, a 76-years-old man, diagnosed with Stage Ⅲa rectal cancer, underwent Hartmann's operation. The lung metastasis was confirmed in July and November 2013, surgical resection for pulmonary metastasis was performed 2 times. In January 2016, he had difficulty of speaking, and isolated brain tumor was found. We performed surgical resection of brain metastasis in February 2016. In March and July 2016, the gamma knife radiosurgery was performed for other brain metastasis. In July 2016, he occurred nausea, headache and right identity hemi-blindness. Two new brain tumors were revealed. We performed surgical resection again. Three months after second brain surgery, he had dysarthria and a solitary brain tumor was confirmed. We performed third neurosurgical resection. All tumors of brain were found to be metastasis from rectal cancer in histological study. Currently, 16 months have passed since the first diagnosis of brain metastasis of this patient, and the quality of life was good relatively. The prognosis of the patients with brain metastasis is poor generally. However, this case suggested that multiple surgical resection of brain metastasis could improve prognosis and quality of life of patients. Accumulation of further cases is needed.
要旨
症例は76歳,男性。2012年3月にStage Ⅲaの直腸癌に対しHartmann手術が施行された。2013年7月,11月に肺転移を認め,いずれも肺部分切除術を施行された。2016年1月にろれつ困難を認め,精査で孤立性脳腫瘍を指摘されたため2月に開頭腫瘍摘出術を施行した 。3月 ,7月に後頭葉の新たな病変に対しガンマナイフ療法を施行した 。7月に嘔気・頭痛・右同名性半盲を認め,精査したところ新たな脳腫瘍を指摘され,開頭腫瘍摘出術を施行した。9月に構語障害を発症し,孤立性脳腫瘍を認めたため開頭腫瘍摘出術を施行した。3回の脳腫瘍の病理診断では,いずれも直腸癌の脳転移であった。自験例では3回の腫瘍摘出,2回の放射線療法を行ったが,脳転移診断時より16か月の生存が得られており,QOLも比較的保たれていた。大腸癌原発の転移性脳腫瘍に対し複数回の手術を行うことは,予後およびQOLを改善し得る可能性が示唆された。