Fujiwara Yasuhiro, Ioka Tatsuya, Matsui Hiroto, Tokumitsu Yukio, Shindo Yoshitaro, Matsukuma Satoshi, Nakajima Masao, Yamada Kensuke, Watanabe Yusaku, Tomochika Shinobu, Yoshida Shin, Iida Michihisa, Suzuki Nobuaki, Takeda Shigeru, Nagano Hiroaki
Dept. of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2021 Dec;48(13):2085-2087.
An 80 year-old woman with anorexia and jaundice was diagnosed with mass-forming intrahepatic cholangiocarcinoma, lymph node metastasis, common hepatic duct strictures, and obstructive jaundice. PET-CT showed FDG accumulation in the primary lesion(SUVmax 19.0)and swollen lymph nodes. Her ADL and major organ functions were judged to be sufficient for treatment. After treatment for jaundice, she received a total of 6 courses of gemcitabine, cisplatin plus S-1(GCS)therapy as neoadjuvant chemotherapy(NAC). Her first treatment was an 80% dose of GCS, but she was subsequently diagnosed with Grade 4 thrombocytopenia(CTCAE v5.0). The dose of gemcitabine was further reduced, and no adverse events of Grade 3 or higher were observed thereafter. After NAC, PET-CT showed decreased FDG accumulation in the primary lesion(SUVmax 3.3)and normalization of FDG accumulation in the lymph nodes. Extended right hepatectomy and biliary reconstruction were performed as radical resection(R0). The final diagnosis was pT2, N0, M0, Stage Ⅱ. After hepatectomy, her anorexia and poor ADL persisted. She was discharged to her home 151 days after her surgery.
一名80岁患有厌食症和黄疸的女性被诊断为肿块型肝内胆管癌、淋巴结转移、肝总管狭窄和梗阻性黄疸。PET-CT显示原发灶（SUVmax 19.0）和肿大淋巴结中有FDG聚集。她的日常生活活动能力（ADL）和主要器官功能被判定足以接受治疗。在进行黄疸治疗后，她接受了总共6个疗程的吉西他滨、顺铂加S-1（GCS）疗法作为新辅助化疗（NAC）。她的首次治疗采用80%剂量的GCS，但随后被诊断为4级血小板减少症（CTCAE v5.0）。吉西他滨的剂量进一步降低，此后未观察到3级或更高等级的不良事件。新辅助化疗后，PET-CT显示原发灶中FDG聚集减少（SUVmax 3.3），淋巴结中FDG聚集恢复正常。实施了扩大右肝切除术和胆道重建作为根治性切除（R0）。最终诊断为pT2，N0，M0，Ⅱ期。肝切除术后，她的厌食症和较差的日常生活活动能力仍然存在。术后151天她出院回家。
