Ichikawa Yoshitoshi, Yamada Daisaku, Eguchi Hidetoshi, Iwagami Yoshifumi, Noda Takehiro, Asaoka Tadafumi, Wada Hiroshi, Kawamoto Koichi, Gotoh Kunihito, Kobayashi Shogo, Tatsumi Mitsuaki, Takeyari Misa, Mori Masaki, Doki Yuichiro
Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
Gan To Kagaku Ryoho. 2017 Nov;44(12):2014-2016.
A 70-year-old man was diagnosed with pancreatic ductal adenocarcinoma(PDAC)with peritoneal dissemination and received systemic chemotherapy of gemcitabine(GEM)plus nab-paclitaxel. Since the patient could not continue the regimen due to an adverse event of liver dysfunction, he was administered GEM alone except for the first administration. GEM monotherapy resulted in remarkable anti-tumor effects with a distinct decrease of both tumor markers and size. Peritoneal metastases were not detected in images after 12 courses of the GEM regimen, and the vanished tumor metastasis in images was maintained until 16 courses were administered. After the laparoscopic examination proved no peritoneal metastasis, we performed curative surgery. The presence of peritoneal metastasis of PDAC indicated that it was at a lethal stage; however, a few cases were reported as receiving curative surgery after chemotherapy with modest long-term survival. We herein report a rare case of curative surgery following chemotherapy with GEM alone for unresectable PDAC accompanied with peritoneal dissemination.
一名70岁男性被诊断为伴有腹膜播散的胰腺导管腺癌（PDAC），并接受了吉西他滨（GEM）联合白蛋白结合型紫杉醇的全身化疗。由于肝功能障碍这一不良事件，患者无法继续该治疗方案，除首次给药外，他仅接受了GEM单药治疗。GEM单药治疗产生了显著的抗肿瘤效果，肿瘤标志物和肿瘤大小均明显减小。在接受12个疗程的GEM治疗方案后，影像学检查未发现腹膜转移，且在给予16个疗程治疗前，影像学上消失的肿瘤转移灶一直保持未出现。在腹腔镜检查证实无腹膜转移后，我们进行了根治性手术。PDAC出现腹膜转移表明处于致命阶段；然而，有少数病例报告称在化疗后接受了根治性手术，并获得了适度的长期生存。我们在此报告一例罕见病例，对于伴有腹膜播散的不可切除PDAC，仅使用GEM化疗后进行了根治性手术。
