Shimizu Takeshi, Inaba Seishiro, Nakata Masashi, Matsushita Yuki, Araki Yasunobu, Koyama Hiroshi, Ogino Atsuhiro, Yamada Eiji, Matsuyama Tomohiko
Dept. of Surgery, National Nara Hospital.
Gan To Kagaku Ryoho. 2003 Feb;30(2):283-7.
A 68-year-old male with a history of gastric resection for gastric cancer underwent resection of the sigmoid colon for a sigmoid colon cancer in February, 2000. The cancer was classified as stage III b. After operation, l-LV + 5-FU therapy was administered, but metastases to the abdominal wall, right inguinal lymph node and spleen developed in succession, and resection was repeated. In October 2001, 1 year and 8 months after sigmoidectomy, however, multiple metastasis to the intraperitoneal lymph node had developed. As surgery was not indicated, TS-1/CDDP combined chemotherapy was started. TS-1 80 mg/day was administered for 4 weeks, the drug was withdrawn for 2 weeks and CDDP 80 mg was injected by intravenous drip at the 8th day of TS-1 administration, which was used as one course. From the second course after inception of the administration, CA19-9 decreased, and after the third course the upper intraperitoneal metastatic lesion disappeared on CT. CR has been continued for 4 months up to the present. Our results suggest a possibility that this therapy is effective not only for gastric cancer but also for colon cancer. This therapy can be administered at home. It is considered to be a useful therapy from the viewpoint of QOL as well. The high DPD activity of the tumor may have been one reason this treatment was effective. This case also seems significant from the viewpoint of attaining individualization of the drug selection in chemotherapy.
一名68岁男性,有因胃癌行胃切除术史,于2000年2月因乙状结肠癌接受乙状结肠切除术。癌症被分类为III b期。术后给予左旋亚叶酸钙(l-LV)+氟尿嘧啶(5-FU)治疗,但相继出现腹壁、右腹股沟淋巴结及脾脏转移,并再次进行了切除手术。然而,在乙状结肠切除术后1年8个月的2001年10月,出现了腹腔内淋巴结多发转移。由于不适合手术,遂开始采用替吉奥(TS-1)/顺铂(CDDP)联合化疗。TS-1 80mg/天给药4周,停药2周,并在TS-1给药的第8天静脉滴注CDDP 80mg,作为一个疗程。自给药开始的第二个疗程起,糖类抗原19-9(CA19-9)下降,第三个疗程后CT显示腹腔上部转移灶消失。截至目前,完全缓解(CR)已持续4个月。我们的结果提示这种疗法不仅对胃癌有效,对结肠癌也可能有效。这种疗法可在家中给药。从生活质量(QOL)的角度来看,它也被认为是一种有用的疗法。肿瘤的二氢嘧啶脱氢酶(DPD)活性高可能是这种治疗有效的原因之一。从实现化疗药物选择个体化的角度来看,该病例似乎也具有重要意义。