Fujita Takahisa, Shimizu Yoshio, Dongping Feng, Yamamoto Naoki, Kobayashi Mitsuyoshi, Iwabu Hiroyuki, Tsuji Akihito
Dept. of Gastroenterological Surgery, Takamatsu Hospital.
Gan To Kagaku Ryoho. 2020 Nov;47(11):1597-1600.
We report a case of unresectable advanced esophagogastric junction carcinoma that was treated with nab-paclitaxel and ramucirumab, which resulted in complete response and salvage surgery. A 57-year-old male complained of upper abdominal discomfort. While attending a hospital for diabetes mellitus, upper gastrointestinal endoscopy was performed. A tumor protruding from the gastric cardia to the abdominal esophagus was found, and histological examination revealed well-differentiated adenocarcinoma. Multiple liver metastases and para-aortic lymph node metastases were found on abdominal contrast-enhanced CT. The patient was diagnosed with stage Ⅳ cancer, and chemotherapy was performed as unresectable advanced esophagogastric junction carcinoma. S-1 plus CDDP therapy was started as the first-line treatment. After 2 courses of S-1 plus CDDP therapy, tumor markers were elevated. Further, the cancer was judged to be highly toxic and refractory to treatment; therefore, we started nab-paclitaxel and ramucirumab as the secondary treatment. After 4 courses, normalization of tumor markers, disappearance of liver metastases, and marked reduction of enlarged lymph nodes were observed. However, PET-CT showed increased uptake, consistent with the primary lesion. Residual cancer could not be ruled-out; therefore, total gastrectomy was performed. Histopathological examination of the surgically resected specimen showed no residual tumors.
我们报告了一例不可切除的晚期食管胃交界癌患者，该患者接受了纳米白蛋白结合型紫杉醇和雷莫西尤单抗治疗，最终获得完全缓解并接受了挽救性手术。一名57岁男性主诉上腹部不适。因糖尿病就医期间，进行了上消化道内镜检查。发现一个从胃贲门向腹段食管突出的肿瘤，组织学检查显示为高分化腺癌。腹部增强CT发现多发肝转移和主动脉旁淋巴结转移。该患者被诊断为Ⅳ期癌症，作为不可切除的晚期食管胃交界癌进行化疗。一线治疗开始使用S-1加顺铂。S-1加顺铂治疗2个疗程后，肿瘤标志物升高。此外，判断该癌症毒性高且对治疗耐药；因此，我们开始使用纳米白蛋白结合型紫杉醇和雷莫西尤单抗作为二线治疗。4个疗程后，观察到肿瘤标志物恢复正常、肝转移消失且肿大淋巴结明显缩小。然而，PET-CT显示摄取增加，与原发灶一致。不能排除残留癌；因此，进行了全胃切除术。手术切除标本的组织病理学检查未发现残留肿瘤。
