Hasegawa Hirofumi, Hashimoto Takashi, Nakamura Toshihiko, Kitagawa Masaru, Kudo Kensuke, Shoji Fumihiro, Kabashima Akira, Teramoto Seiichi, Kitamura Masayuki
Dept. of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Japan.
Gan To Kagaku Ryoho. 2012 Nov;39(12):2234-6.
The patient was a 68-year-old man. Because sigmoid colon cancer and metastatic liver cancer was diagnosed in August 2009, an indwelling central venous port and sigmoid colon resection were implemented. The metastatic liver cancer was a huge tumor occupying the right hepatic lobe and caudate lobe. In consideration of the risk associated with the resection and the possibility of early recurrence, the postoperative chemotherapy was selected. He underwent 9 courses of bevacizumab (Bev)+FOLFOX. The tumor was observed to reduce but continued to occupy the right lobe and caudate lobe. At this point, the surgical treatment was selected because the tumor has been shrunk and there is no appearance of new metastases. In order to preserve residual liver function, he underwent percutaneous transhepatic portal embolization and then resection of the right lobe of the liver in February 2010. Although the Bev+FOLFOX treatment was started again after surgery as adjuvant chemotherapy, the metastatic liver cancer recurred in the remnant liver in August 2010. Because it was about 6 months from the first recurrence of liver resection, we decided to continue chemotherapy immediately without resection. However, the chemotherapy was insufficient to shrink the tumor, which increased because it was present at 3 locations in the liver. Therefore, partial hepatectomy at the 3 locations with positron-emission tomography was performed in February 2011. Since then, chemotherapy has not been performed in patients, and there is no recurrence as of March 2012. In the guideline for the treatment of liver metastasis of colorectal cancer, even though chemotherapy is currently developed, the surgical procedure is recommended for patients who are responsive to local therapy. If the cancer recur immediately after resection, it is difficult to decide whether to re-resect. We report the case in which the tumor-free status can be observed as a result of a combination of systemic chemotherapy and local therapy.
该患者为一名68岁男性。2009年8月被诊断为乙状结肠癌伴肝转移癌，遂行中心静脉导管留置术及乙状结肠切除术。肝转移癌为巨大肿瘤，占据右肝叶及尾状叶。考虑到手术风险及早期复发的可能性，选择了术后化疗。患者接受了9个疗程的贝伐单抗（Bev）+FOLFOX化疗。肿瘤体积缩小，但仍占据右叶及尾状叶。此时，鉴于肿瘤已缩小且无新转移灶出现，选择了手术治疗。为保留残余肝功能，患者于2010年2月先行经皮经肝门静脉栓塞术，随后行右肝叶切除术。术后虽再次开始使用Bev+FOLFOX进行辅助化疗，但2010年8月肝转移癌在残余肝脏复发。由于距首次肝切除复发约6个月，我们决定立即继续化疗而不进行手术切除。然而，化疗不足以使肿瘤缩小，因肝脏3个部位均有肿瘤，肿瘤反而增大。因此，2011年2月对这3个部位进行了正电子发射断层扫描引导下的部分肝切除术。此后，患者未再进行化疗，截至2012年3月无复发。在结直肠癌肝转移的治疗指南中，尽管目前化疗不断发展，但对于对局部治疗有反应的患者仍推荐手术治疗。如果切除后癌症立即复发，很难决定是否再次切除。我们报告了通过全身化疗与局部治疗相结合可实现无瘤状态的病例。
