Yanagisawa Shinji, Tsuchiya Shunichi, Kaiho Takashi, Togawa Akira, Shinmura Kazuyasu, Okamoto Ryo, Nishimura Masaki, Nomura Satoru, Nobumoto Daigo, Miyazaki Masaru
Dept. of Surgery, Kimitsu Chuo Hospital, Graduate School of Medicine, Chiba University.
Gan To Kagaku Ryoho. 2010 Feb;37(2):307-10.
The patient was a 68-year-old man with melena. Endoscopic examination revealed a type 2 advanced tumor in the mid body and an elevated lesion in the upper body of the stomach. Biopsy specimens from both lesions were diagnosed histologically as squamous cell carcinoma. Abdominal CT showed thickening of the midbody in the greater curvature and bulky lymph nodes along the lesser curvature (No. 3), and the greater curvature(No. 4d). We diagnosed Stage IIIB (cP0, cH0, cT4, cN1, cM0) cancer, but we concluded radical resection would be difficult due to lymph node invasion to the diaphragm and mesocolon. DCF combination therapy (docetaxel 75 mg/m2 day 1, CDDP 75 mg/m2 day 1, 5-FU 750 mg/m2 day 1-5) was administered. After 3 courses of chemotherapy, endoscopic examination and abdominal CT findings showed remarkable reduction of the primary tumor and the lymph node metastasis, indicating a partial response (PR) to the chemotherapy. After consultation with the patient, total gastrectomy with lymph node dissection (D2) was performed. The pathological specimens showed no cancer cells in the gastric wall and lymph nodes, so the histological effect was judged as Grade 3. This case suggested that DCF combination chemotherapy may prove useful to treat patients with advanced squamous cell carcinoma of the stomach.
患者为一名68岁男性，有黑便症状。内镜检查发现胃体中部有2型进展期肿瘤，胃上部有一隆起性病变。两处病变的活检标本经组织学诊断为鳞状细胞癌。腹部CT显示胃大弯中部增厚，沿小弯（第3组）和大弯（第4d组）有肿大淋巴结。我们诊断为IIIB期（cP0，cH0，cT4，cN1，cM0）癌症，但由于淋巴结侵犯膈肌和结肠系膜，我们认为根治性切除困难。给予DCF联合化疗（多西他赛75mg/m²，第1天；顺铂75mg/m²，第1天；5-氟尿嘧啶750mg/m²，第1 - 5天）。3个疗程化疗后，内镜检查和腹部CT结果显示原发肿瘤和淋巴结转移明显缩小，提示化疗部分缓解（PR）。与患者协商后，行全胃切除术加淋巴结清扫（D2）。病理标本显示胃壁和淋巴结无癌细胞，因此组织学疗效判定为3级。该病例提示DCF联合化疗可能对治疗晚期胃鳞状细胞癌患者有用。
