Ishida Hiroyuki, Seyama Yasuji, Ome Yusuke, Matsumura Masaru, Nemoto Satoshi, Doi Manami, Muto Jun, Hayakawa Sara, Karasawa Katsuyuki, Horio Hirotoshi, Horiguchi Shinichiro, Honda Goro
Dept. of Hepatobiliary and Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital.
Gan To Kagaku Ryoho. 2020 Feb;47(2):340-342.
We report a case of pulmonary metastasis from hilar cholangiocarcinoma successfully treated by stereotactic body radiotherapy. The patient was a 70-year-old woman who underwent extended left hemi-hepatectomy with bile duct reconstruction for hilar cholangiocarcinoma at the age of 67. Pathological diagnosis indicated a well-differentiated adenocarcinoma. We followed up the patient without adjuvant chemotherapy. Nineteen months after the initial resection, a solitary pulmonary metastasis was detected in the right upper lobe. The patient received gemcitabine plus cisplatin(GC)therapy. After 4 courses of GC therapy, the size of the pulmonary metastasis was unchanged. Therefore, we performed a thoracoscopic wedge resection. Pathological diagnosis indicated that the pulmonary metastasis originated from the cholangiocarcinoma. Fifteen months after the pulmonary resection, another solitary pulmonary metastasis was detected in the left lower lobe. As the patient refused further chemotherapy, we performed stereotactic body radiotherapy(SBRT)(50 Gy/4 Fr). An adverse event of Grade 1 radiation pneumonitis was observed. The metastasis disappeared after SBRT. Twenty-eight months after SBRT and 70 months after the initial surgery, the patient is alive without recurrence.
我们报告一例肝门部胆管癌肺转移患者，通过立体定向体部放疗成功治愈。患者为一名70岁女性，67岁时因肝门部胆管癌接受了扩大左半肝切除术及胆管重建术。病理诊断为高分化腺癌。我们对患者进行随访，未给予辅助化疗。初次切除术后19个月，右上叶发现孤立性肺转移灶。患者接受了吉西他滨联合顺铂（GC）治疗。4个疗程的GC治疗后，肺转移灶大小未变。因此，我们进行了胸腔镜楔形切除术。病理诊断表明肺转移灶起源于胆管癌。肺切除术后15个月，左下叶又发现一个孤立性肺转移灶。由于患者拒绝进一步化疗，我们进行了立体定向体部放疗（SBRT）（50 Gy/4次分割）。观察到1级放射性肺炎这一不良事件。SBRT后转移灶消失。SBRT后28个月，初次手术后70个月，患者存活且无复发。
