Muroya Takahiro, Wajima Naoki, Kubo Norihito, Yoshida Eri, Akaishi Takanobu, Umetsu Satoko, Yoshida Tatsuya, Wakasa Yusuke, Sato Kentaro, Mitsuhashi Yuto, Umemura Kotaro, Ogasawara Hirokazu, Hara Yutaro, Hakamada Kenichi
Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2018 Dec;45(13):2066-2068.
The REGARD and RAINBOW trials revealed the effectiveness of ramucirumab(RAM)for advanced gastric cancer patients who had been previously treated with chemotherapy. In the latest Japanese gastric cancer treatment guidelines, PAM plus paclitaxel(PTX)was positioned as a second-line chemotherapy for advanced gastric cancer. We report a case of advanced gastric cancer with peritoneal dissemination after gastrectomy effectively treated with RAM plus PTX. A 66-year-old woman underwent total gastrectomy with D2 lymph node dissection, splenectomy, and distal pancreatectomy. The pathological diagnosis was poorly differentiated adenocarcinoma, pT4b(pancreas), N3b, P1, CY1, Stage Ⅳ. She was treated with postoperative chemotherapy of S-1 plus cisplatin. However, 5 months after surgery, computed tomography(CT)showed ascites and recurrence of peritoneal dissemination. Cytological examination showed adenocarcinoma cells in the ascites. She was treated with combination chemotherapy of RAM and PTX as second line chemotherapy. After 1 course of this therapy, CT revealed complete disappearance of ascites and significant reduction in the size of the peritoneal dissemination. The patient survived without progression for 8 months after the recurrence was detected.
REGARD和RAINBOW试验揭示了雷莫西尤单抗（RAM）对先前接受过化疗的晚期胃癌患者的有效性。在最新的日本胃癌治疗指南中，RAM联合紫杉醇（PTX）被定位为晚期胃癌的二线化疗方案。我们报告了1例胃癌切除术后发生腹膜播散的晚期胃癌患者，经RAM联合PTX治疗有效。一名66岁女性接受了D2淋巴结清扫、脾切除和远端胰腺切除的全胃切除术。病理诊断为低分化腺癌，pT4b（胰腺），N3b，P1，CY1，Ⅳ期。她接受了S-1联合顺铂的术后化疗。然而，术后5个月，计算机断层扫描（CT）显示有腹水和腹膜播散复发。细胞学检查显示腹水中有腺癌细胞。她接受了RAM和PTX联合化疗作为二线化疗。经过1个疗程的这种治疗后，CT显示腹水完全消失，腹膜播散的大小显著减小。在检测到复发后，患者存活且无进展8个月。
