Sugimoto Kiichi, Tashiro Yoshihiko, Nagayasu Kiichi, Niwa Kouichiro, Ono Seigo, Ishiyama Shun, Hata Masaki, Komiyama Hiromitsu, Takahashi Makoto, Yaginuma Yukihiro, Kojima Yutaka, Goto Michitoshi, Tanaka Masanobu, Sengoku Hironobu, Okuzawa Atsushi, Tomiki Yuichi, Sakamoto Kazuhiro
Department of Coloproctological Surgery, Juntendo University.
Gan To Kagaku Ryoho. 2010 Jun;37(6):1167-70.
The patient, a male in his 70s, was referred to this hospital by his neighborhood doctor with what was said to be impaired hepatic function. Detailed examinations revealed a circumferential ascending colon cancer, diffuse hepatic metastases scattered over both liver lobes, and lymph node metastases in the left axilla. With the primary lesion-induced symptoms of stenosis controllable, the patient began systemic chemotherapy by mFOLFOX6 without a resection of the primary lesion. After completing a 10-course treatment, the patient underwent surgery to resect the primary lesion in preparation for bevacizumab treatment. In the postoperative systemic chemotherapy, FOLFIRI and mFOLFOX6 were administered concomitantly with bevacizumab. After a total of 19 courses, the patient's systemic condition gradually deteriorated. He eventually died of cancer one year and seven months after diagnosis of the primary lesion or one year and one month subsequent to the resection of the primary lesion. No consensus has been reached on the necessity to resect the primary lesion in patients with advanced colorectal cancer who also have unresectable distal metastases. Systemic chemotherapy, nevertheless, can provide tumor control on both primary and metastatic lesions and could become a treatment option in the future.
该患者为一名70多岁的男性，由社区医生转诊至本院，据称其肝功能受损。详细检查发现升结肠癌呈环形，肝两叶均有弥漫性肝转移，左腋窝有淋巴结转移。由于原发灶引起的狭窄症状可控，患者未切除原发灶即开始接受mFOLFOX6全身化疗。完成10个疗程的治疗后，患者接受手术切除原发灶，为使用贝伐单抗治疗做准备。在术后全身化疗中，FOLFIRI和mFOLFOX6与贝伐单抗联合使用。总共进行19个疗程后，患者的全身状况逐渐恶化。他最终在诊断出原发灶一年零七个月后或切除原发灶一年零一个月后死于癌症。对于同时伴有不可切除的远处转移的晚期结直肠癌患者是否有必要切除原发灶，目前尚未达成共识。然而，全身化疗可以控制原发灶和转移灶的肿瘤，未来可能成为一种治疗选择。
