ガンマナイフと化学療法により長期生存をえた直腸癌多発脳, 肺転移の1例 Long-term Survival of a Case with Brain and Lung Metastases from Rectal Cancer Treated by Gamma Knife Radiosurgery and Chemotherapy

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症例は51歳,男性.直腸癌で,1996年8月低位前方切除,D3郭清を行った.病理組織学的検査では,RaRb, 3型,43×42mm,中分化腺癌,SE, ly2, v1, N1, P0, H0, M0, Stage IIIaであった.術後は5'-DFURを内服していたが,1998年9月胸部CTで多発肺転移を認め,FP, UFTとPSKの内服,低用量CPT-11, 5'DFURとPSKの内服,IFL療法などを続けた.肺転移は著変なく経過した.2002年8月,脳MRIで小脳転移を認め,ガンマナイフ治療を行った.その後,小脳,大脳に新たな転移が出現し,2006年1月まで合計11回,20カ所(小脳5カ所,大脳15カ所)のガンマナイフ治療を施行したが,脳転移出現後も,明らかな神経学的異常を認めず,通常通り就労していた.しかし2006年5月,術後9年9カ月(肺転移後7年8カ月,脳転移後3年9カ月)で死亡した.多発脳転移,肺転移をともなった直腸癌に対して,ガンマナイフと化学療法により長期生存をえることができた.<br>

A 51-year-old male with rectal cancer underwent low anterior resection with extended lymph node dissection. Histological examination showed moderately differentiated adenocarcinoma invading non-peritonealized perirectal tissues with lymph node metastases. Adjuvant chemotherapy with 5'-DFUR was performed postoperatively. Twenty-five months after the operation, chest CT revealed multiple lung metastases. Chemotherapy with low dose FP, UFT and PSK, low dose CPT-11, 5'-DFUR and PSK, IFL were performed, and lung metastases were stable for 47 months. Seventy-two months after the operation, brain MRI showed metastasis in the right cerebellum, and gamma knife radiosurgery was performed. Six months after radiosurgery, new metastases were detected in the cerebellum and cerebrum. Further gamma knife radiosurgery was carried out for 41 months (eleven times for 5 regions in the cerebellum, and 15 regions in the cerebrum). Neurological abnormality did not develop during this treatment. He died 117 months after the operation (92 months after the detection of lung metastases, 45 months after the detection of brain metastases). Gamma knife radiosurgery combined with chemotherapy resulted in long survival for this patient with far advanced rectal cancer with brain and lung metastases.<br>

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  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(4), 169-174, 2008-04-01 

    The Japan Society of Coloproctology

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