Nakagawa Kan, Koike Shoichiro, Matsumura Hideyasu, Yokoi Kenta, Kitamura Hiroshi
Dept. of Surgery, National Hospital Organization, Matsumoto Medical Center, Matsumoto Hospital.
Gan To Kagaku Ryoho. 2012 Apr;39(4):671-4.
A 73-year-old man with a diagnosis of rectal cancer concomitant with multiple liver metastases underwent resection of the primary lesion. The postoperative immunohistochemical study revealed AFP production in the cancer tissue. The initial serum level of AFP after operation was 721 ng/mL. Although the mFOLFOX6 regimen had been started as the first postoperative chemotherapy, the AFP is serum level aggressively elevated to 9, 521 ng/mL and the size of the liver metastases markedly increased. As a second choice of treatment, transarterial chemo-embolization(TACE)using epirubicin hydrochloride and Lipiodol was performed because it was reported to have a high efficacy. After two sessions of the TACE, the serum level of the AFP decreased to 130 ng/mL and the size of the liver metastases reduced by approximately 30%in diameter. The third session of TACE, however, was unable to prevent re-progression of the liver lesion and the development of lung metastases. The patient died of hepatic failure 9 months after operation. It is known that AFP-producing colorectal cancers frequently develop life-limiting liver metastases. As shown in the present case, transcatheter drug delivery exclusively to the lesion in the liver might be the first choice for improving patient survival.
一名诊断为直肠癌伴多发肝转移的73岁男性接受了原发灶切除。术后免疫组化研究显示癌组织中有甲胎蛋白生成。术后甲胎蛋白初始血清水平为721 ng/mL。尽管术后首次化疗已开始采用mFOLFOX6方案，但甲胎蛋白血清水平急剧升至9521 ng/mL，肝转移灶大小明显增大。作为二线治疗选择，采用盐酸表柔比星和碘油进行经动脉化疗栓塞术（TACE），因为据报道其疗效较高。经过两次TACE治疗后，甲胎蛋白血清水平降至130 ng/mL，肝转移灶直径缩小约30%。然而，第三次TACE治疗未能阻止肝脏病变的再进展和肺转移的发生。患者术后9个月死于肝衰竭。已知产生甲胎蛋白的结直肠癌常发生危及生命的肝转移。如本病例所示，仅向肝脏病变部位进行经导管药物递送可能是提高患者生存率的首选方法。
