Tsuji Y, Hamada H, Kimura J, Matsumoto S, Fujimori A, Hasegawa K, Yamagami H, Katsuki Y, Ohira S
Dept. of Surgery, Nikko Memorial Hospital.
Gan To Kagaku Ryoho. 2000 Oct;27(12):1966-9.
We report three cases in which CR was maintained after infusion (WHF) was performed for residual metastatic lesions following resection of hepatic metastases from colorectal cancer. (Case 1) A 55-year-old female with sigmoidal cancer and hepatic metastases, H2 (4 lesions). Right lobectomy and partial resection of the left lobe were performed. On the third month following surgery, CT showed two lesions in the lateral segment of the left lobe, and WHF was then begun. One month after the start of infusion, the lesions calcified and following that, disappeared. Infusion was performed for 12 months and the total amount of 5-FU was 52.8 g. Eight years and nine months following surgery, the patient is currently alive and without recurrence. (Case 2) A 65-year-old male with rectal cancer and hepatic metastases, H3 (6 lesions). Four lesions were removed by hepatic resection; however, 2 deep lesions in S4 and S5 were left unresected. WHF was begun one month following surgery, following which the lesions were undetectable by either CT or US. Infusion was performed for 18 months and the total amount of 5-FU was 81 g. Two years and ten months after surgery an isolated lung metastasis was discovered in the right lung and a thoracoscopic partial resection was performed. Eight years and four months following the original surgery and five years and four months following the lung operation the patient is alive and without recurrence. (Case 3) A 55-year-old male with rectal cancer and subsequently discovered hepatic metastases, H3 (5 lesions). Resection of the lateral segment and a partial resection of the right lobe were performed; however, one deep lesion in S7 was left unresected. WHF was begun on the 10th day following surgery. At about eight months there was a change in shape and shrinkage of the lesion. Infusion was performed for 11 months and the total amount of 5-FU was 48 g. Ten months following surgery, CT showed a new lesion in S7 and a partial resection was performed. Intraoperative US confirmed the disappearance of the previous residual lesion in S7. One year and one month following the original surgery, the patient is alive and without recurrence. From these results, it is suggested that with postoperative WHF it is possible to obtain a complete cure in cases of colorectal cancer with hepatic metastases without the resection of all lesions. (*WHF: 5-FU 1,000 mg/m2/5 hrs/week).
我们报告了3例在结直肠癌肝转移灶切除术后，针对残留转移病灶进行灌注（WHF）后维持完全缓解（CR）的病例。（病例1）一名55岁女性，患有乙状结肠癌并伴有肝转移，H2（4个病灶）。行右叶切除术及左叶部分切除术。术后第3个月，CT显示左叶外侧段有2个病灶，随后开始进行WHF。灌注开始1个月后，病灶钙化，随后消失。灌注持续12个月，5-氟尿嘧啶（5-FU）总量为52.8g。术后8年9个月，患者目前仍存活且无复发。（病例2）一名65岁男性，患有直肠癌并伴有肝转移，H3（6个病灶）。通过肝切除术切除了4个病灶；然而，S4和S5的2个深部病灶未切除。术后1个月开始进行WHF，之后CT及超声均未检测到病灶。灌注持续18个月，5-FU总量为81g。术后2年10个月，在右肺发现孤立性肺转移灶，行胸腔镜下部分切除术。原手术8年4个月及肺手术后5年4个月，患者仍存活且无复发。（病例3）一名55岁男性，患有直肠癌，随后发现肝转移，H3（5个病灶）。行外侧段切除术及右叶部分切除术；然而，S7的1个深部病灶未切除。术后第10天开始进行WHF。大约8个月时，病灶形状改变并缩小。灌注持续11个月，5-FU总量为48g。术后10个月，CT显示S7有一个新病灶，行部分切除术。术中超声证实先前S7残留病灶已消失。原手术1年1个月后，患者仍存活且无复发。从这些结果来看，提示对于结直肠癌肝转移患者，即使未切除所有病灶，术后进行WHF也有可能实现完全治愈。（*WHF：5-FU 1000mg/m²/5小时/周）
