Wada Yuma, Okada Kazuyuki, Ebisui Chikara, Kato Ryo, Makino Shunichiro, Takeoka Tomohira, Yanagisawa Tetsu, Okamura Shu, Fukuchi Nariaki, Murata Kouhei, Yokouchi Hideoki, Kinuta Masakatsu
Dept. of Surgery, Suita Municipal Hospital.
Gan To Kagaku Ryoho. 2013 Nov;40(12):2244-6.
A 66-year-old man underwent distal gastrectomy with Roux-en-Y anastomosis and D2 dissection for the treatment of advanced gastric cancer (pT4a, N0, M0, stage IIB) in June 2009. He was treated with adjuvant postoperative chemotherapy consisting of S-1. However, in September 2010, computed tomography (CT) showed #16a2 lymph node recurrence, which was treated with combination chemotherapy of S-1 and cisplatin. After 7 courses of this combination chemotherapy, CT revealed a significant reduction in the size of the metastatic lesion as well as a new peritoneal dissemination recurrence around the right kidney. We therefore changed the regimen to combination chemotherapy of S-1 and docetaxel. After 3 courses of this treatment, the dissemination lesion was no longer evident by CT. After 6 more courses of treatment, the lymph node and peritoneal dissemination recurrence showed no regrowth. In response to the patient's wish, we changed the chemotherapy to S-1 alone beginning in June 2012. He survived without recurrence for approximately 2 years after gastrectomy. We suggest that the taxane drug was effective as second-line chemotherapy for the treatment of patients with peritoneal dissemination recurrence.
一名66岁男性于2009年6月接受了远端胃切除术，行Roux-en-Y吻合术及D2淋巴结清扫术，以治疗进展期胃癌（pT4a，N0，M0，IIB期）。他接受了以替吉奥为主的辅助术后化疗。然而，2010年9月，计算机断层扫描（CT）显示#16a2淋巴结复发，遂接受替吉奥和顺铂的联合化疗。经过7个疗程的这种联合化疗后，CT显示转移灶大小显著缩小，同时右肾周围出现新的腹膜播散复发。因此，我们将治疗方案改为替吉奥和多西他赛的联合化疗。经过3个疗程的这种治疗后，CT显示播散灶不再明显。再经过6个疗程的治疗后，淋巴结及腹膜播散复发未见再生长。应患者要求，从2012年6月起我们将化疗改为单纯使用替吉奥。胃切除术后他存活且无复发约2年。我们认为紫杉烷类药物作为二线化疗药物对治疗腹膜播散复发患者有效。
