Tanabe T, Nashimoto A, Sasaki J, Sano M, Tanaka O, Tsutsui M, Tsuchiya Y, Makino H, Yabusaki H, Akiyama N, Ohta T
Division of Surgery, Niigata Cancer Center Hospital.
Gan To Kagaku Ryoho. 1999 Nov;26(13):2073-6.
A 73-year-old woman was admitted to our hospital in June 1998, suffering from upper abdominal pain. The upper G-I series and endoscopic examination revealed stenosis of the pylorus and antrum by a type 2 cancer, and a poorly differentiated adenocarcinoma and a signet-ring cell carcinoma were confirmed on endoscopic biopsy. A CT scan showed the enlargement of many regional and abdominal para-aortic lymph nodes. FLP therapy combined with cisplatin (50 mg/m2 drip i.v., day 1-8), 5-fluorouracil (333 mg/m2 drip i.v.) and leucovorin (30 mg/body i.v., day 1-8) was planned for neoadjuvant chemotherapy (NAC) in order to reduce or eliminate the tumor and increase curability. After two cycles of the FLP therapy, the tumor size shrunk remarkably and the enlargement of the para-aortic lymph nodes disappeared. Distal gastrectomy with extended lymphadenectomy and cholecystectomy was performed. The histological findings of the primary tumor and metastatic lymph nodes demonstrated massive cancer cell degeneration such as pycnosis and vacuolation, xanthogranulomatous inflammation and dense fibrosis. The effect of NAC was judged to be grade 2 histologically. FLP therapy is an effective and safe regimen for NAC.
一名73岁女性于1998年6月因上腹部疼痛入住我院。上消化道造影和内镜检查显示幽门和胃窦部有2型癌导致的狭窄，内镜活检确诊为低分化腺癌和印戒细胞癌。CT扫描显示多个区域及腹主动脉旁淋巴结肿大。计划采用氟尿嘧啶（5-氟尿嘧啶）、亚叶酸钙和顺铂联合的FLP方案进行新辅助化疗（NAC），以缩小或消除肿瘤并提高治愈率。经过两个周期的FLP治疗后，肿瘤大小显著缩小，腹主动脉旁淋巴结肿大消失。行远端胃切除术、扩大淋巴结清扫术和胆囊切除术。原发肿瘤和转移淋巴结的组织学检查发现大量癌细胞变性，如核固缩和空泡形成、黄色肉芽肿性炎症和致密纤维化。NAC的组织学效果判定为2级。FLP方案是一种有效且安全的NAC治疗方案。
