Yamamoto Kazuyoshi, Fujitani Kazumasa, Tsujinaka Toshimasa, Hirao Motohiro, Nishikawa Kazuhiro, Fukuda Yasunari, Haraguchi Naotsugu, Miyake Masakazu, Asaoka Tadafumi, Miyamoto Atsushi, Omiya Hideyasu, Ikeda Masataka, Takami Koji, Nakamori Shoji, Sekimoto Mitsugu
Dept. of Surgery, Osaka National Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):2296-8.
A 62-year-old man presented with type 3 gastric cancer (tub1, HER2 positive) in the cardia, with 10-cm direct invasion into the lower esophagus, and extensive lymph node metastasis (Virchow and paraaortic nodes). Trastuzumab (Her), in the XP regimen (capecitabine and cisplatin [CDDP] plus Her; Xeloda®: 2,000 mg/m² on day 1-14, CDDP: 80 mg/m² on day 1, Her: 8(6) mg/kg on day 1), was administered every 3 weeks and repeated for 6 courses. After administering 6 courses of the XP plus Her regimen, without severe adverse events in the patient, computed tomography (CT) revealed shrinkage of both the main tumor and the metastatic sites, by 51%. Esophagectomy and proximal gastrectomy with 3-field lymphadenectomy and gastric tube reconstruction was performed via right thoracotomy and laparotomy (R0). However, Grade 3 pneumonia occurred postoperatively, and the patient was discharged on day 67 after surgery. After treatment, the tumor was histologically evaluated as Grade 1b gastric cancer, and remnant cancer cells also expressed HER2. The patient was too frail to receive adjuvant chemotherapy, and he died of pneumonia 11 months after surgery, without obvious relapse. Perioperative chemotherapy with a regimen containing Her has a possible role in treating advanced HER2-positive gastric cancer. Multiple invasive conversion surgeries might decrease the feasibility of adjuvant chemotherapy and worsen the prognosis.
一名62岁男性，贲门部出现3型胃癌（tub1，HER2阳性），肿瘤直接侵犯食管下段达10厘米，并有广泛淋巴结转移（Virchow淋巴结和主动脉旁淋巴结）。采用XP方案（卡培他滨和顺铂[CDDP]加曲妥珠单抗[Her]；希罗达®：第1 - 14天2000 mg/m²，CDDP：第1天80 mg/m²，Her：第1天8(6)mg/kg），每3周给药1次，共重复6个疗程。在给予6个疗程的XP加Her方案后，患者未出现严重不良事件，计算机断层扫描（CT）显示主要肿瘤和转移部位均缩小了51%。通过右胸切开术和剖腹术进行了食管切除术和近端胃切除术，并进行了三野淋巴结清扫和胃管重建（R0切除）。然而，术后发生了3级肺炎，患者于术后第67天出院。治疗后，肿瘤经组织学评估为1b级胃癌，残留癌细胞也表达HER2。患者身体过于虚弱，无法接受辅助化疗，术后11个月死于肺炎，无明显复发。含Her方案的围手术期化疗在治疗晚期HER2阳性胃癌中可能具有一定作用。多次侵袭性转化手术可能会降低辅助化疗的可行性并恶化预后。
