Köksal N, Müftüoglu T, Günerhan Y, Uskent N
Haydarpasa Numune Teaching and Research Hospital, Second Department of Surgery, Istanbul, Turkey.
Hepatogastroenterology. 2000 May-Jun;47(33):612-4.
The prognosis of anorectal malignant melanoma is very poor. We present a 48-year-old male patient with anorectal malignant melanoma and multiple liver metastases who underwent abdominoperineal resection. A port system was implanted to the gastroduodenal artery for regional chemotherapy for liver metastases. Histopathological findings of tumor were 5 cm diameter and 2 cm depth, invading to the external sphincter. Both regional chemotherapy and immunotherapy were initiated 4 weeks postoperatively. The immunochemotherapy regimen included cisplatin (via port system) 50 mg/m2 once in 2 weeks, x 8 cycles, alpha-interferon 5 x 10(6) U subcutaneously on days 1-7 in 4 weeks, x 8 cycles, interleukin-2 9 x 10(6) U subcutaneously on days 5-9 in 4 weeks, x 8 cycles. Computed tomography scan was taken after the 2nd and 4th cycles of chemotherapy and the tumor had not responded to chemotherapy. Dacarbazine 200 mg/m2 intravenously on days 1-5 in a month, x 4 cycles, was added to the previous immunochemotherapy regimen. Computed tomography and magnetic resonance imaging scans were taken on the 10th and 12th months after operation, respectively, no evidence of metastases in the liver was noted. No case of complete remission of liver metastases of anorectal malignant melanoma with regional intraarterial chemotherapy and systemic immunochemotherapy has been previously reported in the literature.
肛管直肠恶性黑色素瘤的预后非常差。我们报告一名48岁男性肛管直肠恶性黑色素瘤伴多发肝转移患者,该患者接受了腹会阴联合切除术。通过在胃十二指肠动脉植入一个端口系统进行肝转移灶的区域化疗。肿瘤的组织病理学检查结果显示直径为5 cm,深度为2 cm,侵犯至外括约肌。术后4周开始进行区域化疗和免疫治疗。免疫化疗方案包括:顺铂(通过端口系统)50 mg/m²,每2周1次,共8个周期;α-干扰素5×10⁶ U,在4周内的第1 - 7天皮下注射,共8个周期;白细胞介素-2 9×10⁶ U,在4周内的第5 - 9天皮下注射,共8个周期。在化疗的第2个和第4个周期后进行计算机断层扫描,肿瘤对化疗无反应。在前述免疫化疗方案中加入达卡巴嗪200 mg/m²,在1个月内的第1 - 5天静脉注射,共4个周期。分别在术后第10个月和第12个月进行计算机断层扫描和磁共振成像扫描,未发现肝脏有转移迹象。此前文献中尚未报道过肛管直肠恶性黑色素瘤肝转移灶通过区域动脉化疗和全身免疫化疗实现完全缓解的病例。