Kuwahara A, Hirao E, Shimoda K, Yoshida T, Miyahara M, Saito T, Kobayashi M
First Dept. of Surgery, Medical College of Oita.
Gan To Kagaku Ryoho. 1990 Dec;17(12):2425-8.
The case was a 82-year-old man with advanced gastric Borrmann 3 cancer on the posterior wall of the cardia. Laparotomy revealed peritoneal dissemination (P3) and liver metastasis (H1). Because of his advanced age and on the basis of local findings, gastrectomy was not performed. In order to treat peritoneal dissemination with two-route chemotherapy, two tubes were placed beneath the cul-de-sac of Douglas and the left subphrenic cavity and at the same time, for the purpose of intra-arterial chemotherapy, one more tube was inserted into the proper hepatic artery. At day 12 and day 25 after the operation, 5-FU (500 mg)-Lipiodol (10 ml) emulsion was infused through the tube inserted into the proper hepatic artery. Within 24 hours following the infusion, hyperthermotherapy was carried out at 42 degrees C for 40 minutes. In addition, two-route chemotherapy with CDDP (100 mg)-STS was given at day 14 and day 28 after the operation. Furthermore, one course of FAM [5-FU (1,500 mg), ADM (30 mg) and MMC (10 mg)] therapy was initiated five weeks after the operation. Although no further chemotherapy was performed thereafter, both gastric endoscopy and CT scanning disclosed complete disappearance of the tumor one year after the operation. This result suggests that combined chemotherapy according to the part of progression is effective for advanced gastric cancer.
该病例为一名82岁男性，患有位于贲门后壁的进展期胃Borrmann 3型癌。剖腹探查发现腹膜播散（P3）和肝转移（H1）。由于患者年龄较大且根据局部检查结果，未进行胃切除术。为了通过双途径化疗治疗腹膜播散，在Douglas陷凹和左膈下间隙下方放置了两根导管，同时，为了进行动脉内化疗，在肝固有动脉内又插入了一根导管。术后第12天和第25天，通过插入肝固有动脉的导管注入5-氟尿嘧啶（500 mg）-碘油（10 ml）乳剂。在注入后24小时内，进行42℃、持续40分钟的热疗。此外，在术后第14天和第28天给予顺铂（100 mg）-丝裂霉素双途径化疗。此外，术后五周开始一个疗程的FAM[5-氟尿嘧啶（1500 mg）、阿霉素（30 mg）和丝裂霉素（10 mg）]治疗。尽管此后未再进行化疗，但术后一年胃镜检查和CT扫描均显示肿瘤完全消失。该结果表明，根据进展部位进行联合化疗对进展期胃癌有效。
