Imamura Mikio, Yamaki Takayuki, Yasuda Mitsuhiko
Dept. of Surgery, Sendai National Hospital.
Gan To Kagaku Ryoho. 2003 Dec;30(13):2101-5.
A 41-year-old male complaining of epigastric discomfort visited another hospital for a medical checkup. Gastrointestinal fiberscopic examination revealed a type 3 lesion on the lesser curvature of the lower portion, and biopsy specimens showed tubular adenocarcinoma. Abdominal CT demonstrated multiple liver metastases. After receiving a low-dose FP chemotherapy via IVH catheter for 1 week, the patient undertook a distal gastrectomy accompanied by D2 lymph node dissection. From the 19th postoperative day (POD), hepatic arterial infusion chemotherapy (HAIC) using 5-FU (500 mg/day) plus CDDP (10 mg/day) was performed for about 14 months. On the 47th POD, oral administration of UFT began and continued for 2 years. After 4 months of HAIC, the metastatic lesions of the liver disappeared completely. The patient has been free from recurrence since then for about 2 years. In the peripheral blood, Th1/Th2 ratio and activity of NK/LAK (IL-2 induced) kept increasing during this period. IHAC using 5-FU plus CDDP seems to be an efficient and worthy therapeutic modality if there are no other lesions except multiple liver metastases and a curative gastric resection is indicated.
一名41岁男性因上腹部不适前往另一家医院进行体检。胃肠纤维镜检查显示胃下部小弯处有3型病变，活检标本显示为管状腺癌。腹部CT显示有多处肝转移。通过静脉留置导管接受低剂量FP化疗1周后，患者接受了远端胃切除术并进行了D2淋巴结清扫。术后第19天（POD）起，使用5-氟尿嘧啶（500毫克/天）加顺铂（10毫克/天）进行肝动脉灌注化疗（HAIC），持续约14个月。术后第47天开始口服优福定，并持续2年。HAIC治疗4个月后，肝脏转移病灶完全消失。此后患者约2年无复发。在此期间，外周血中Th1/Th2比值以及NK/LAK（IL-2诱导）活性持续升高。如果除多处肝转移外无其他病变且适合进行根治性胃切除术，使用5-氟尿嘧啶加顺铂的肝动脉灌注化疗似乎是一种有效且值得采用的治疗方式。
