Makino Hironobu, Kametaka Hisashi, Koyama Takashi, Seike Kazuhiro
Dept. of Surgery, Odawara City Hospital.
Gan To Kagaku Ryoho. 2011 Dec;38(13):2647-50.
A 62-year-old woman with a diagnosis of pancreatic cancer with splenic invasion, liver metastasis, and peritoneal dissemination was scheduled to receive chemotherapy. However, emergency surgery was performed because of an exacerbation of ileus. Laparotomy revealed moderate ascites and innumerable nodular lesions on the mesenteric side of the small intestine and colon. Peritoneal dissemination was associated with many sites of stenosis in the small intestine and colon. Surgery was performed to resect cancer of the tail of the pancreas (the primary tumor) and to permit the oral intake of food. The postoperative course was good, with no complications. On the 19th hospital day, gemcitabine was started as first-line chemotherapy. Tumor marker levels promptly decreased and remained within the normal range for 6 months. The patient received 17 courses of chemotherapy. Tumor marker levels increased subsequently, and chemotherapy was switched to S-1 as second-line treatment. Twelve courses were delivered, and tumor marker levels decreased again. Erlotinib was then added to S-1, and treatment was continued. Tumor marker levels decreased after adding erlotinib, even when there was no further response to S-1 alone. At present, the patient is receiving combined therapy with S-1 and irinotecan and has survived for 3 years and 1 month after surgery. Our findings suggest that S-1-based chemotherapy for second-line and subsequent treatment contributed to long-term survival.
一名62岁女性，诊断为胰腺癌伴脾侵犯、肝转移和腹膜播散，计划接受化疗。然而，由于肠梗阻加重而进行了急诊手术。剖腹探查发现中度腹水，小肠和结肠肠系膜侧有无数结节性病变。腹膜播散伴有小肠和结肠多处狭窄。手术切除了胰尾癌（原发肿瘤），使患者能够经口进食。术后恢复良好，无并发症。住院第19天，开始使用吉西他滨作为一线化疗。肿瘤标志物水平迅速下降，并在6个月内保持在正常范围内。患者接受了17个疗程的化疗。随后肿瘤标志物水平升高，化疗改为S-1作为二线治疗。给予12个疗程，肿瘤标志物水平再次下降。然后在S-1中添加厄洛替尼并继续治疗。添加厄洛替尼后，即使对单独使用S-1不再有反应，肿瘤标志物水平仍下降。目前，患者正在接受S-1和伊立替康的联合治疗，术后已存活3年1个月。我们的研究结果表明，基于S-1的二线及后续治疗化疗有助于长期生存。
