Tokoro Tomokazu, Nakamura Keishi, Hirose Atsushi, Nakanuma Shinichi, Okamoto Kohichi, Kinoshita Jun, Makino Isamu, Hayashi Hironori, Oyama Katsunobu, Miyashita Tomoharu, Tajima Hidehiro, Takamura Hiroyuki, Ninomiya Itasu, Fushida Sachio, Ohta Tetsuo
Dept. of Gastroenterological Surgery, Kanazawa University.
Gan To Kagaku Ryoho. 2018 Mar;45(3):521-523.
The patient was a 57-year-old woman. Preclinical examination of malignant lymphoma revealed 0-I sp type of early rectal cancer in the upper rectum, 20 cm from the anal margin. Endoscopic mucosal resection was performed and positive deep margins were pathologically diagnosed. Additional intestinal resection with lymph node dissection was deemed necessary, but ABVD therapy was initiated because the clinical stage of the malignant lymphoma was Stage III b or higher. Two months after detecting elevated CEA, S8 liver metastasis was pointed out, and examination of weakness of the right upper limb revealed nodular, multifocal brain metastasis. After chemotherapy for malignant lymphoma, bevacizumab(BV)plus Xelox therapy was initiated. After administering 4 courses, partial loss of multiple brain metastases and reduction of the liver metastatic lesion were confirmed; therefore, partial resection of the liver via laparoscopy was performed. After surgery, BV plus Xelox therapy was resumed, but since the lower lobular lung metastasis was confirmed after 8 courses, partial resection of the left lower lobe with thoracoscopy was performed. After lung resection, BV plus FOLFIRI therapy was administered, and 12 months after the onset of treatment for brain metastasis, recurrence was not detected.
患者为一名57岁女性。恶性淋巴瘤的临床前检查发现距肛缘20 cm的直肠上段有0-I sp型早期直肠癌。进行了内镜黏膜切除术,病理诊断切缘深部阳性。虽然认为有必要进行额外的肠切除及淋巴结清扫,但由于恶性淋巴瘤的临床分期为III b期或更高,因此开始进行ABVD治疗。在检测到癌胚抗原(CEA)升高两个月后,发现肝S8转移,对右上肢无力的检查显示有结节状、多灶性脑转移。在对恶性淋巴瘤进行化疗后,开始使用贝伐单抗(BV)联合希罗达(Xelox)疗法。给药4个疗程后,确认多处脑转移部分消失,肝转移灶缩小;因此,通过腹腔镜进行了肝部分切除术。手术后,恢复了BV联合Xelox疗法,但在8个疗程后确认有下叶肺转移,于是通过胸腔镜进行了左下叶部分切除术。肺切除术后,给予BV联合氟尿嘧啶/亚叶酸钙/伊立替康(FOLFIRI)疗法,在脑转移治疗开始12个月后未检测到复发。