Matsutani Takeshi, Uchida Eiji, Yoshida Hiroshi, Suzuki Seiji, Maruyama Hiroshi, Yokoyama Tadashi, Matsushita Akira, Hirakata Atsushi, Kawamoto Masao, Arai Hiroki, Umakoshi Michinobu, Wakabayashi Hideyuki, Sasajima Koji
Dept. of Surgery, Nippon Medical School Tama-nagayama Hospital, Japan.
Gan To Kagaku Ryoho. 2011 Mar;38(3):439-41.
A 78-year-old male was admitted to our hospital because of dysphagia. He had been diagnosed as nephritic syndrome at 30 years of age and had been treated with prednisolone 10 mg/day. Blood examination revealed renal dysfunction; BUN 25 mg/dL, Cr 1. 9 mg/dL, and glomerular filtration rate(GFR)47. 4 mL/min. Endoscopy showed a type 2 tumor at the middle thoracic esophagus, and the biopsy specimen revealed moderately differentiated squamous cell carcinoma pathologically. Computed tomography (CT) of the chest and abdomen showed no metastases at distant regions and lymph nodes. Clinical staging was Stage II (cT2cN0cM0). Because of old age and renal function, we chose chemotherapy using docetaxel, nedaplatin and 5-fluorouracil. The adverse event was grade 2 in leucopenia and grade 1 in inappetence, but the renal function did not progress. Repeated endoscopic examinations after chemotherapy revealed that the esophageal cancer was significantly reduced in size, and no cancer cells were pathologically detected by endoscopic biopsy, resulting in a complete response(CR). This chemotherapy of docetaxel, nedaplatin and 5-fluorouracil might be effective and tolerable for patients with renal dys- function due to nephritic syndrome.
一名78岁男性因吞咽困难入院。他30岁时被诊断为肾病综合征，一直接受每日10毫克泼尼松龙治疗。血液检查显示肾功能不全；血尿素氮25毫克/分升，肌酐1.9毫克/分升，肾小球滤过率（GFR）47.4毫升/分钟。内镜检查显示胸段食管中段有2型肿瘤，活检标本病理显示为中分化鳞状细胞癌。胸部和腹部计算机断层扫描（CT）显示远处区域和淋巴结无转移。临床分期为II期（cT2cN0cM0）。由于患者年龄较大且存在肾功能问题，我们选择使用多西他赛、奈达铂和5-氟尿嘧啶进行化疗。不良事件为白细胞减少2级，食欲不振1级，但肾功能未进展。化疗后反复内镜检查显示食管癌大小显著缩小，内镜活检病理未检测到癌细胞，达到完全缓解（CR）。这种多西他赛、奈达铂和5-氟尿嘧啶的化疗方案可能对因肾病综合征导致肾功能不全的患者有效且耐受性良好。
