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[低剂量顺铂与持续氟尿嘧啶动脉灌注治疗胃癌孤立性肝转移的有效病例]

[An effective case of arterial infusion therapy of low-dose CDDP and continuous 5-FU for isolated hepatic recurrence of gastric carcinoma].

作者信息

Akamo Y, Takeyama H, Mohri N, Teranishi F, Ohara E, Kawashima N, Hayakawa T, Fukui T, Tanaka M, Mizuno I, Manabe T

机构信息

First Dept. of Surgery, Nagoya City University Medical School.

出版信息

Gan To Kagaku Ryoho. 1999 Oct;26(12):1945-7.

Abstract

We report an effective case of arterial infusion therapy of low-dose CDDP and continuous 5-FU for isolated hepatic recurrence of gastric carcinoma. An 83-year-old man was admitted for epigastric pain and vomiting due to a huge liver metastasis of gastric carcinoma in May, 1997. Nineteen months earlier, in October of 1995, he had undergone distal gastrectomy and D2 lymph node dissection with Billroth I reconstruction. His conclusive stage and pathological findings were as follows. The conclusive stage was stage II: t3, n0, P0, H0. Histological typing was tub 2. Lymph node involvement was not detected, but venous invasion was found in the surrounding regional lymph nodes. CEA had been getting elevated from November, 1996. But he had been well until March, 1997, when CT scans revealed huge hepatic recurrence. The artery-side port was placed for hepatic arterial infusion therapy for liver metastasis. Intra-arterial bolus injection of low-dose CDDP (5 mg) and continuous intra-arterial infusion of 5-FU (250 mg/day for 7 days) were started. Through 4 courses of this arterial infusion therapy, the patient improved. CT scans revealed shrinking of liver metastasis after 3 months of this therapy. The patient was followed in an outpatient clinic and continued to receive this arterial infusion therapy once every 4 weeks. New lung metastasis was detected 9 months after the start, but liver metastasis continued to be responded. The patient died from bleeding into the bile duct from the liver metastasis 16 months after the start of arterial infusion therapy, when metastatic lesions of liver continued to shrink. Arterial infusion therapy of low-dose CDDP and continuous 5-FU may be effective for isolated hepatic recurrence of gastric carcinoma.

摘要

我们报告了一例低剂量顺铂动脉灌注联合持续5-氟尿嘧啶治疗胃癌孤立性肝转移的有效病例。一名83岁男性因胃癌巨大肝转移于1997年5月因上腹部疼痛和呕吐入院。19个月前,即1995年10月,他接受了远端胃切除术及D2淋巴结清扫术,行毕Ⅰ式重建。其最终分期及病理结果如下。最终分期为Ⅱ期:t3,n0,P0,H0。组织学类型为tub 2。未发现淋巴结受累,但在周围区域淋巴结发现静脉侵犯。癌胚抗原自1996年11月开始升高。但直到1997年3月他情况一直良好,当时CT扫描显示巨大肝转移。放置动脉侧端口用于肝转移的肝动脉灌注治疗。开始动脉内推注低剂量顺铂(5mg)并持续动脉内输注5-氟尿嘧啶(250mg/天,共7天)。经过4个疗程的这种动脉灌注治疗,患者病情改善。该治疗3个月后CT扫描显示肝转移灶缩小。患者在门诊随访,并继续每4周接受一次这种动脉灌注治疗。开始治疗9个月后发现新的肺转移,但肝转移仍有反应。动脉灌注治疗开始16个月后,患者因肝转移灶出血进入胆管死亡,此时肝转移灶持续缩小。低剂量顺铂动脉灌注联合持续5-氟尿嘧啶治疗可能对胃癌孤立性肝转移有效。

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