Uchida Yoichiro, Denno Ryusuke, Obama Kazutaka, Kinoshita Koichi, Kanai Michiyuki, Takabayashi Arimichi
Dept. of Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
Gan To Kagaku Ryoho. 2002 Nov;29(11):1995-9.
The patient, a 53-year-old male, underwent radical surgery for advanced gastric cancer (stage IV). On the second day after surgery, adjuvant chemotherapy consisting of 250 mg/day 5-FU (i.v.) for 14 days, followed by 450 mg/day of UFT-E for about 12 months, was initiated. About 21 months after surgery (7 months after cessation of medication), the CA19-9 level had risen (136 U/ml). After 26 months, the patient experienced a backache and his CEA and CA19-9 levels had risen 11.7 ng/ml and 869 U/ml, respectively. The results from an imaging examination were suggestive of multiple bone metastases and para-aortic lymphatic metastasis. Chemotherapy was resumed with only TS-1 (100 mg/day). Because the tumor markers (TM) continued to rise, he was hospitalized and the medication was combined with daily administration of 10 mg of CDDP (TS-1 + CDDP protocol). When the total dose of CDDP reached 160 mg, there was a dramatic drop in the TM (surrogate marker) level. The patient was discharged and medication of TS-1 and 10 mg/day of CDDP twice a week was continued on an outpatient basis. Five months after the initial administration of FP, the CEA and CA19-9 returned to normal levels (4.3 ng/ml and 33 U/ml, respectively). Metastases to the para-aortic lymph nodes had disappeared and the sites of bone metastases were reduced in size. The patient was able to resume his full social activities. Since that time, a second-line therapy has been added. Currently (about two years after the recurrence), he is still undergoing therapy with TS-1 + CDDP.
该患者为一名53岁男性，因晚期胃癌（IV期）接受了根治性手术。术后第二天，开始进行辅助化疗，静脉注射5-氟尿嘧啶（5-FU），剂量为250毫克/天，持续14天，随后服用优福定（UFT-E），剂量为450毫克/天，持续约12个月。术后约21个月（停药7个月后），糖类抗原19-9（CA19-9）水平升高（136 U/ml）。26个月后，患者出现背痛，癌胚抗原（CEA）和CA19-9水平分别升至11.7纳克/毫升和869 U/ml。影像学检查结果提示多发骨转移和主动脉旁淋巴结转移。仅恢复使用替吉奥（TS-1，100毫克/天）进行化疗。由于肿瘤标志物（TM）持续升高，患者住院治疗，药物联合每日静脉注射10毫克顺铂（CDDP，TS-1+CDDP方案）。当顺铂总剂量达到160毫克时，TM（替代标志物）水平急剧下降。患者出院，门诊继续服用TS-1并每周两次静脉注射10毫克顺铂。首次使用FP方案五个月后，CEA和CA19-9恢复至正常水平（分别为4.3纳克/毫升和33 U/ml）。主动脉旁淋巴结转移消失，骨转移部位缩小。患者能够恢复全面的社交活动。自那时起，增加了二线治疗。目前（复发后约两年），他仍在接受TS-1+CDDP治疗。
