Shimizu Teruhisa, Shigemasa Yu, Kajiwara Keiji, Sasaki Nobufumi, Ikari Hideki, Kunizaki Tadaomi, Yonemitsu Nobuhisa
Department of Surgery, Sasebo Chuo Hospital.
Gan To Kagaku Ryoho. 2009 Nov;36(12):2149-51.
The patient was an 85-year-old man who underwent a rt-hemicolectomy, cholecystectomy and choledocholithotomy for cecum cancer and bile duct stone. The tumor was a well differentiated adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma. The tumor was considered to be in stage II (ss, ly2, v0, n (-), P0, H0, M (-)). He did not receive any adjuvant chemotherapy. After 2 years and 3 months from the surgery, an abdominal MRI and an abdominal CT scan revealed a 30 mm hepatic nodule lesion. We diagnosed with liver metastasis of the cecum cancer. The patient refused both surgery and radio-frequency ablation therapy. We chose radiotherapy for liver metastasis. He was given a total dose of 50 Gy/25 fractions. After 3 months from the radiotherapy, the tumor was reduced gradually and tumor marker (CEA) was normalized. The disease was diagnosed as CR because no tumors were detected. There has been no liver recurrence. But after 4 years and 6 months from the surgery, 20 mm lung nodules in rt-lower lung were revealed by chest X-ray. Once more, we chose radiotherapy for lung tumor. He was given a total dose of 66 Gy/33 fractions. At present, the tumor was reduced gradually. There has been no recurrence since his irradiation. If the case was made a good choice, radiation therapy appears to be effective for liver and lung tumors from the colorectal cancer.
该患者为一名85岁男性，因盲肠癌和胆管结石接受了右半结肠切除术、胆囊切除术和胆总管切开取石术。肿瘤为高分化腺癌，在日本结直肠癌分类中为2型。肿瘤被认为处于II期（ss，ly2，v0，n（-），P0，H0，M（-））。他未接受任何辅助化疗。手术后2年3个月，腹部MRI和腹部CT扫描显示肝脏有一个30 mm的结节性病变。我们诊断为盲肠癌肝转移。患者拒绝手术和射频消融治疗。我们选择对肝转移灶进行放射治疗。给予他的总剂量为50 Gy/25次分割。放疗3个月后，肿瘤逐渐缩小，肿瘤标志物（CEA）恢复正常。由于未检测到肿瘤，疾病被诊断为完全缓解（CR）。此后一直没有肝脏复发。但手术后4年6个月，胸部X线检查发现右下肺有20 mm的肺结节。我们再次选择对肺部肿瘤进行放射治疗。给予他的总剂量为66 Gy/33次分割。目前，肿瘤逐渐缩小。自放疗后一直没有复发。如果病例选择得当，放射治疗似乎对结直肠癌的肝转移和肺转移肿瘤有效。
