Teraishi Fuminori, Uno Futoshi, Kagawa Shunsuke, Gochi Akira, Fujiwara Toshiyoshi, Tanaka Noriaki
Dept. of Gastroenterological Surgery, Okayama University Graduate School of Medicine and Dentistry, Japan.
Gan To Kagaku Ryoho. 2006 Nov;33(12):1885-7.
A 69-year-old man with no sign of symptoms was admitted to our hospital for further examination and treatment of gastric cancer. Endoscopy revealed a Borrmann 3-type tumor in the cardia of the stomach. CT of the abdomen demonstrated a marked thickening of the stomach wall near the esophago-gastric junction, multiple liver metastases in bilateral liver lobes, and regional lymph node swelling around the cardia of the stomach. He consented and received systemic chemotherapy consisting of 0.5 h infusion of cisplatin (25 mg/body) followed by 0.5 h infusion of gemcitabine (800 mg/body) and 2.5 h infusion of irinotecan (60 mg/body) every 14 days as described below. Only the initial 1 course was administered with 5-FU (500 mg/body) as an inpatient, and further courses were performed as an outpatient with no severe adverse events. His tumors responded immediately to the chemotherapy, and restaging abdominal CT after 4-cycles of chemotherapy showed almost complete regression of liver metastases, and partial response to lymphadenopathy. The patient currently undergoes regular chemotherapy and remains in remission more than 6 months after the diagnosis of unresectable gastric cancer with liver metastases. It may be possible that the current chemotherapy will be neoadjuvant chemotherapy, and curative surgical resection can be performed.
一名69岁无症状男性因胃癌进一步检查和治疗入院。内镜检查发现胃贲门部有Borrmann 3型肿瘤。腹部CT显示食管胃交界处附近胃壁明显增厚，双侧肝叶多发肝转移，胃贲门周围区域淋巴结肿大。他同意并接受了如下所述的全身化疗，每14天进行一次，顺铂（25mg/体）输注0.5小时，随后吉西他滨（800mg/体）输注0.5小时，伊立替康（60mg/体）输注2.5小时。仅最初1个疗程作为住院患者给予5-氟尿嘧啶（500mg/体），后续疗程作为门诊患者进行，未出现严重不良事件。他的肿瘤对化疗立即产生反应，化疗4个周期后复查腹部CT显示肝转移几乎完全消退，淋巴结病变部分缓解。该患者目前正在接受规律化疗，在诊断为不可切除的伴有肝转移的胃癌后6个月以上仍处于缓解期。目前的化疗有可能成为新辅助化疗，从而可以进行根治性手术切除。
