Oneda Yasuo, Tamura Shigeyuki, Murakami Kouhei, Takeno Atsushi, Kuwahara Ryuichi, Akiyama Yasuki, Sakamoto Takuya, Inatome Junichi, Naito Atushi, Katsura Yoshiteru, Ohmura Yoshiaki, Kagawa Yoshinori, Egawa Chiyomi, Takeda Yutaka, Kato Takeshi
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2202-2204.
A 70-year-old-man, whose chief complaint was epigastric pain, was referred to our hospital and diagnosed with advanced gastric cancer with multiple liver metastases. Gastrointestinal endoscopy showed a tumor on the anterior wall of the gastric lower body. Histologically, biopsy specimens indicated adenocarcinoma, and immunohistochemistry showed positive expression of HER2(3+). Chest and abdominal computed tomography showed multiple liver metastases and lymph node metastases. We started chemotherapy with capecitabine, cisplatin, and trastuzumab. Abdominal CT showed the primary tumor and metastases to be reduced after 3 courses, but a ringed enhanced space occupying lesion in the liver had appeared, which was diagnosed as a liver abscess. After administering antibiotics and performing percutaneous transhepatic abscess drainage (PTAD), we continued XPT chemotherapy. The patient received 6 courses of XPT, 15 courses of capecitabine and trastuzumab, and 6 courses of trastuzumab alone, and has remained progression free in the 1 year and 5 months after diagnosis. We experienced a case of advanced gastric cancer with multiple liver metastases successfully treated with capecitabine, cisplatin, and trastuzumab.
一名70岁男性,主要症状为上腹部疼痛,被转诊至我院,诊断为晚期胃癌伴多发肝转移。胃肠内镜检查显示胃下壁前壁有肿瘤。组织学检查显示活检标本为腺癌,免疫组化显示HER2呈阳性表达(3+)。胸部和腹部计算机断层扫描显示多发肝转移和淋巴结转移。我们开始使用卡培他滨、顺铂和曲妥珠单抗进行化疗。腹部CT显示3个疗程后原发肿瘤和转移灶缩小,但肝脏出现环形强化的占位性病变,诊断为肝脓肿。给予抗生素并进行经皮肝脓肿穿刺引流(PTAD)后,我们继续进行XPT化疗。患者接受了6个疗程的XPT、15个疗程的卡培他滨和曲妥珠单抗以及6个疗程的单纯曲妥珠单抗治疗,诊断后1年零5个月病情无进展。我们成功治疗了一例晚期胃癌伴多发肝转移患者,采用了卡培他滨、顺铂和曲妥珠单抗。