Vp4肝細胞癌の肺・脳転移に対し集学的治療により著効が得られた1例 A case of Vp4 hepatocellular carcinoma with lung and brain metastases, successfully treated by multimodal therapy

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症例は66歳の男性.門脈本幹に腫瘍栓の進展を認める肝細胞癌に対してlow dose FP動注療法を行いCRが得られた.以後外来にて5-Fu 750 mgの動注治療を1年4カ月にわたり継続した.治療開始2年後に両側の多発性肺転移・単発脳転移を認めた.QOLを考慮し脳の転移巣を切除し,5-Fuを基本とした全身化学療法(CDDPおよびEPIを併用)を行なうも効果は得られなかった.肺転移の増悪のため化学療法をすべて中止し,十全大補湯(TJ-48)の投与を開始した.十全大補湯投与開始5カ月後に血清AFPおよびPIVKAIIは正常値になり,肺転移巣は痕跡となり,CRを2年維持している.肺転移は化学療法終了時増悪傾向を呈しており,その治癒には十全大補湯が強く関与していると考えられた.文献的考察を加え報告する.<br>

Patient was a 66 years old man with hepatocellular carcinoma (HCC) complicated with tumor thrombus of the main trunk of portal vein (Vp4). Complete remission was obtained by continuous arterial infusion of low dose FP (CDDP+5-FU), followed by intermittent infusion of 5-FU at 750 mg per dose for 16 months. About 24 months after starting the therapy, however, multiple pulmonary metastases and solitary brain metastasis were recognized. He underwent a tumorectomy for the brain metastasis to improve the quality of life, while the multiple pulmonary metastases grew rapidly despite additional courses of systemic chemotherapy (5-FU+CDDP+EPI). Then, about 5 months after the relapse, all the chemotherapy was withdrawn and replaced by an oral administration of Juzen-taiho-to (TJ-48). Five months later, the serum levels of tumor markers (AFP and PIVKA II) had significantly decreased, and the lung tumors had disappeared on CT. Since then until now, the patient has been free from recurrence of HCC for more than 2 years. Because the pulmonary metastases presented an aggravation tendency at the withdrawal of chemotherapy, TJ-48 must have played an important role in the cure.<br>

収録刊行物

  • 肝臓 = ACTA HEPATOLOGICA JAPONICA  

    肝臓 = ACTA HEPATOLOGICA JAPONICA 49(7), 320-326, 2008-07-25 

    The Japan Society of Hepatology

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各種コード

  • NII論文ID(NAID)
    10021939170
  • NII書誌ID(NCID)
    AN00047770
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    04514203
  • NDL 記事登録ID
    9585545
  • NDL 雑誌分類
    ZS21(科学技術--医学--内科学)
  • NDL 請求記号
    Z19-130
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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