Kato Fumiaki, Okada Ryousuke, Enomoto Masaya, Narahashi Yoshiki, Yoriki Ryo, Hashimoto Taijyu, Yoshino Miyuki, Watanabe Masato, Fujino Shozo, Enomoto Masanobu, Ishizaki Tetsuo, Katsumata Kenji, Tsuchida Akihiko
Dept. of Surgery, Niiza Shiki Chuo General Hospital.
Gan To Kagaku Ryoho. 2017 Nov;44(12):1232-1234.
A case is a 46-year-old woman visited us with a chief complaint of bloody stools. A diagnosis of rectal cancer(Rs)was made, and laparoscopic resectomy plus D3 was performed. After progressing to pT4a(SE)N2, M0, pStage III b, postoperative adjuvant chemotherapy(6 courses of XELOX)was administered. Two months after initiating chemotherapy, since the CEA value increased, chest abdominal CT was performed. Five nodules were found in the bilateral lungs and diagnosed as lung metastases(PUL2). Systemic chemotherapy(IRIS plus BV)is administered to PUL2(Grade C)of rectal cancer metachronous metastases. After 3 courses, the effect judgment was SD. Based on the recurrence period from postoperative adjuvant chemotherapy and the findings during this time, it was judged that weight loss surgery was appropriate for the rectal cancer lung metastatic lesions in which chemotherapy was ineffective, and partial resection of both lungs under thoracoscopic assistance was performed. Systemic chemotherapy(TAS-102 plus BV)was initiated to prevent postoperative recurrence. The patient is currently alive without relapse after 12 months. We reported a case of metachronous metastasis of colon cancer in which multidisciplinary treatment was successful.
这是一例46岁女性患者,因便血为主诉前来就诊。诊断为直肠癌(Rs),行腹腔镜切除术加D3清扫术。疾病进展至pT4a(SE)N2、M0、pⅢb期,术后给予辅助化疗(6个疗程的XELOX方案)。化疗开始两个月后,由于癌胚抗原(CEA)值升高,进行了胸部腹部CT检查。双侧肺发现5个结节,诊断为肺转移(PUL2)。对直肠癌异时性转移的PUL2(C级)给予全身化疗(IRIS方案加贝伐单抗)。3个疗程后,疗效判断为疾病稳定(SD)。根据术后辅助化疗后的复发时间及此时的检查结果,判断对化疗无效的直肠癌肺转移灶行减重手术是合适的,遂在胸腔镜辅助下进行了双肺部分切除术。为预防术后复发,开始全身化疗(TAS-102方案加贝伐单抗)。患者目前存活,12个月后未复发。我们报道了一例异时性结肠癌转移且多学科治疗成功的病例。