Haji Yoichi, Mizuma Masamichi, Hayashi Hiroki, Nakagawa Kei, Okada Takaho, Otsuka Hideo, Ottomo Shigeru, Sakata Naoaki, Fukase Koji, Yoshida Hiroshi, Onogawa Tohru, Motoi Fuyuhiko, Naito Takeshi, Rikiyama Toshiki, Katayose Yu, Egawa Shinichi, Unno Michiaki
Dept. of Surgery, Division of Digestive Surgery, Tohoku University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2426-8.
We hypothesized that neoadjuvant chemoradiation therapy for cholangiocarcinoma (NACRAC) using gemcitabine would improve the prognosis of resected cases. Phase II trial of NACRAC is ongoing. We report a very effective case to NACRAC for distal cholangiocarcinoma, which markedly reduced the size and levels of the tumor markers. The patient was a 50- year-old man who presented jaundice. Serum tumor markers were clearly elevated, and abdominal CT scan revealed an enhanced mass in the lower bile duct, a dilatation of the intrahepatic to the middle bile duct and a swollen regional lymph node. After NACRAC, the tumor markers were decreased within a normal range. Also on CT scan, the main tumor was slightly detectable and the swollen node was reduced more than 30% in short diameter. Therefore, the effect of NACRAC was considered PR in RECIST guidelines (ver.1 .1). Pancreaticoduodenectomy was performed 2 weeks after NACRAC. No perioperative complications occurred. Pathological examination showed a good response, Grade 2b on Oboshi-Shimosato's classification. In this case, NACRAC had a good effect in imaging and pathological findings as well as in the tumor markers. Therefore, the neoadjuvant chemoradiation therapy has a potential to improve the prognosis for cholangiocarcinoma.
我们假设，使用吉西他滨的胆管癌新辅助放化疗（NACRAC）可改善手术切除病例的预后。NACRAC的II期试验正在进行中。我们报告了1例NACRAC治疗远端胆管癌的非常有效的病例，该治疗显著缩小了肿瘤大小并降低了肿瘤标志物水平。患者为一名50岁男性，出现黄疸。血清肿瘤标志物明显升高，腹部CT扫描显示肝外胆管下段有强化肿块，肝内胆管至肝外胆管中段扩张，区域淋巴结肿大。NACRAC治疗后，肿瘤标志物降至正常范围。同样在CT扫描中，主肿瘤仅轻微可检测到，肿大淋巴结短径缩小超过30%。因此，根据RECIST指南（第1.1版），NACRAC的疗效被认为是部分缓解（PR）。NACRAC治疗2周后进行了胰十二指肠切除术。未发生围手术期并发症。病理检查显示反应良好，在大oshi-Shimosato分类中为2b级。在该病例中，NACRAC在影像学、病理结果以及肿瘤标志物方面均有良好效果。因此，新辅助放化疗有改善胆管癌预后的潜力。
