Kanemoto Yoshiaki, Tsurita Giichiro, Kurokawa Tomohiro, Azuma Yuki, Yazawa Kentaro, Murakami Yoshinori
Department of Surgery, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan; Division of Molecular Pathology, The Institute of Medical Science, The University of Tokyo, Japan.
Department of Surgery, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan.
Int J Surg Case Rep. 2019;58:186-189. doi: 10.1016/j.ijscr.2019.03.015. Epub 2019 Mar 22.
Chemotherapy is difficult to administer in patients with poor performance status (PS), advanced metastatic lesion, and unresectable colon cancer. We report herein our experience of a patient who showed complete response to chemotherapy and marked PS improvement. The patient presented with the following adverse factors poor PS, advanced progression of metastatic lesions, advanced unresectable colorectal cancer with severe stricture, and old age.
The patient was an 80-year-old male diagnosed with occlusive cancer of the descending colon with multiple metastases in the liver, Stage Ⅳb (National Comprehensive Cancer Network guidelines version 2. 2018). A 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) + panitumumab (Pmab) regimen was successfully administered and led to decreased tumor marker levels; oral intake also became possible. Additional examinations showed that the primary lesion and distant metastatic lesions had almost disappeared; the patient had achieved a near complete response (CR). Currently, 35 cycles of mFOLFOX6＋Pmab have been administered, and his near CR has been maintained for 32 months.
Best supportive care (BSC) is the recommended option for elderly patients with advanced unresectable colon cancer. This is the first case in which an elderly patient with poor PS and advanced unresectable colorectal cancer was treated with combination chemotherapy of mFOLFOX6 + Pmab.
Although the use of chemotherapy for elderly with advanced unresectable colorectal cancer or those with poor PS is limited, this case shows that systemic chemotherapy is now an option for such cases previously managed with BSC.
对于身体状况较差（PS）、有晚期转移病灶且无法切除的结肠癌患者，化疗给药困难。我们在此报告一名对化疗表现出完全缓解且PS显著改善的患者的治疗经验。该患者存在以下不利因素：PS差、转移病灶进展至晚期、伴有严重狭窄的晚期无法切除的结直肠癌以及高龄。
该患者为一名80岁男性，被诊断为降结肠癌伴肝多发转移，Ⅳb期（美国国立综合癌症网络指南2018年第2版）。成功给予了5-氟尿嘧啶、亚叶酸钙和奥沙利铂（mFOLFOX6）+帕尼单抗（Pmab）方案，导致肿瘤标志物水平下降；患者也恢复了经口进食。进一步检查显示，原发灶和远处转移灶几乎消失；患者已达到近乎完全缓解（CR）。目前，已给予35个周期的mFOLFOX6＋Pmab治疗，其近乎CR的状态已维持32个月。
最佳支持治疗（BSC）是晚期无法切除结肠癌老年患者的推荐选择。这是首例对PS差且晚期无法切除的结直肠癌老年患者采用mFOLFOX6 + Pmab联合化疗进行治疗的病例。
尽管对于晚期无法切除的结直肠癌老年患者或PS差的患者，化疗的应用有限，但本病例表明，全身化疗现在是此类以往采用BSC治疗的病例的一种选择。
