Morita Masakatsu, Toyoshima Hideo, Iino Kenzou, Tomita Kenichi, Sasaki Haruka
Dept. of lnternal Medicine II, Fukuoka University Chikushi Hospital, Japan.
Gan To Kagaku Ryoho. 2008 Mar;35(3):479-82.
The patient was a 63-year-old man who consulted our hospital with complaints of a cough and breathing difficulties. His chest CT revealed a 25-mm mass in his right S1 hilar area with spiculation, disseminated nodule in right lung, and pericardial effusions. Also, bronchoscope and TBLB revealed squamous cell carcinoma. This patient was diagnosed as lung cancer (cT4N3M1, stage IV), and chemotherapy was initiated. The chemotherapy was given in the order of CBDCA (AUC3) +GEM (1,000 mg/m(2)), DOC (60 mg/m(2)), and VNR (25 mg/m(2)), and the tumor response was PD. S- 1 (120 mg/body/day, continuous administration for 2 weeks followed by 1 week of rest) was chosen as fourth-line treatment, and a breast CT detected tumor size reduction following completion of the first course. However, after completion of three courses, the breast CT found tumor-enlargement again. Then the chemotherapy was changed to amrubicin (35 mg/m(2)), but the treatment was discontinued due to skin rash. We once experienced a size reduction with S-1, so S-1 (100 mg/body/day, day 1-14) plus CPT-11 (60 mg/m(2), day 1, 7, 14) combination chemotherapy was conducted at 4-week intervals. After two courses were completed, tumor size reduction was observed by breast XP and CT. The response rate was 40.0%. Currently, seven courses were completed, and we will continue this treatment due to the tumor response of SD. The S-1 single treatment and S-1+CPT-11 combination chemotherapy showed efficacy for this difficult case of NSCLC with refractoriness to multiple cancer drug chemotherapy. This combination treatment should be investigated further for its therapeutic benefit.
患者为一名63岁男性，因咳嗽和呼吸困难前来我院就诊。他的胸部CT显示右肺S1肺门区有一个25毫米的肿块，伴有毛刺征，右肺有散在结节，并有心包积液。此外，支气管镜检查和经支气管肺活检显示为鳞状细胞癌。该患者被诊断为肺癌（cT4N3M1，IV期），并开始进行化疗。化疗方案依次为顺铂（AUC3）+吉西他滨（1000mg/m²）、多西他赛（60mg/m²）和长春瑞滨（25mg/m²），肿瘤反应为疾病进展（PD）。选择S-1（120mg/日，连续给药2周，随后休息1周）作为四线治疗，在完成第一个疗程后，胸部CT检测到肿瘤缩小。然而，在完成三个疗程后，胸部CT发现肿瘤再次增大。然后将化疗改为阿霉素（35mg/m²），但由于皮疹而停药。我们曾使用S-1使肿瘤缩小，因此进行了S-1（100mg/日，第1 - 14天）联合伊立替康（60mg/m²，第1、7、14天）的化疗，每4周进行一次。完成两个疗程后，胸部X线平片和CT观察到肿瘤缩小。缓解率为40.0%。目前已完成七个疗程，由于肿瘤反应为疾病稳定（SD），我们将继续这种治疗。S-1单药治疗和S-1 +伊立替康联合化疗对这名对多种抗癌药物化疗耐药的非小细胞肺癌疑难病例显示出疗效。这种联合治疗的治疗益处应进一步研究。
