Hirashima Yoshinori, Kitajima Kazuaki, Sugi Saori, Kagawa Koichi, Kumamoto Toshihide, Murakami Kazunari, Fujioka Toshio, Noguchi Tsuyoshi
Third Dept. of Internal Medicine, Oita University Hospital.
Gan To Kagaku Ryoho. 2006 Apr;33(4):517-9. doi: 10.2217/14750708.3.4.517.
The patient was a 71-year-old man. Chemotherapy was conducted in two courses combining TS-1 (120 mg) and CDDP (80 mg) under the diagnosis of AFP-producing gastric cancer with multiple liver metastasis and peritoneal dissemination. Peritoneal dissemination disappeared, liver metastasis almost disappeared after completion of two courses, and the therapeutic efficacy was rated as PR. Then, the patient underwent distal gastrectomy and lymph node dissection. He received TS-1 monotherapy after surgery, but his condition gradually became worse. TS-1 and CDDP combination were given again, but an ileus resulted due to peritonitis carcinomatous. We therefore administered bi-weekly paclitaxel (80 mg/m(2)) intravenously. The ileus disappeared after one week, liver metastatic lesions and ascites were improved after completion of one course, and therapeutic efficacy was rated as PR. Grade 3 neutropenia and grade 1 alopecia occurred, but no other adverse reaction occurred. This therapy made it possible to eat foods, conduct chemotherapy safely while ambulatory. Paclitaxel can be expected to show good therapeutic efficacy and improve QOL of a peritonitis carcinomatosa patient with TS-1 resistant advanced gastric cancer.
该患者为一名71岁男性。在诊断为伴有多发肝转移和腹膜播散的AFP产生型胃癌的情况下，采用TS-1（120毫克）和CDDP（80毫克）联合进行了两个疗程的化疗。两个疗程结束后，腹膜播散消失，肝转移几乎消失，治疗效果评定为PR。随后，患者接受了远端胃切除术和淋巴结清扫术。术后接受TS-1单药治疗，但病情逐渐恶化。再次给予TS-1和CDDP联合治疗，但因癌性腹膜炎导致肠梗阻。因此，我们每两周静脉注射紫杉醇（80毫克/平方米）。一周后肠梗阻消失，一个疗程结束后肝转移灶和腹水得到改善，治疗效果评定为PR。出现了3级中性粒细胞减少和1级脱发，但未发生其他不良反应。这种治疗方法使患者能够进食，在门诊状态下安全地进行化疗。紫杉醇有望对TS-1耐药的晚期胃癌伴癌性腹膜炎患者显示出良好的治疗效果并改善生活质量。
