進行・再発大腸癌に対する外来・在宅癌化学療法 : リザーバーを用いた5-FU持続静注・CDDP静注併用療法の有用性  [in Japanese] Outpatient or home chemotherapy for advanced or recurrent colorectal cancer : Usefulness of continuous infusion of 5FU with bolus CDDP via subcutaneous implantable reservoir  [in Japanese]

目的:切除不能あるいは再発大腸癌に対し,リザーバーを用いたlow dose 5-fluorouracil: fluorouracil (5-FU)+cis-diamino dichloreplatinum: Cisplatin (CDDP)療法(low dose FP療法)による外来・在宅化学療法を行い,その有用性を評価した.対象および方法:根治切除不能と診断した進行あるいは再発大腸癌23例を対象とし,low dose FP療法(5-FU 300mg/m^2/d, civ, d1-5+CDDP 7mg/m^2/d, iv, d1&4)をProgressive disease (PD)もしくは毒性発現まで施行し,奏効率,生存期間,在宅期間率(在宅期間/生存期間),安全性,医療コストおよびQuality of life (QOL)に関するアンケート結果を検討した.結果:奏効率は17%,No Change (NC)まで含めると83%で,PDに転じるまでの平均期間は8ヵ月であった.また在宅期間率は75%であった.手指の色素沈着11例,口角炎・口内炎5例,嘔気・嘔吐3例,grade2の白血球減少1例等の有害事象が認められたがいずれも軽微であった.カテーテルトラブルは7例に認められ,1例はポートの入れ換えを要した.外来・在宅癌化学療法の経費は入院化学療法に比べ約1/4〜1/5であった.結論:リザーバーを用いた外来・在宅癌化学療法は安全・確実に施行でき,患者のQOLの向上と医療経済面から有用であると考えられた.

Objective: Low-dose 5FU with CDDP therapy was applied to unresectable or recurrent colorectal cancer patients via subcutaneous implantable reservoir. The effectiveness of this treatment was evaluated. Materials and Methods: Twenty-three patients with unresectable or advanced colorectal cancer were analyzed. All patients continued to receive low-dose FP therapy (5FU300mg/m^2/d, civ, d1-5+CDDP 7mg/m^2/d, iv, d1&4) until Progressive Disease or the appearance of the significant toxicity. The following items were analyzed. Efficacy, survival period, ratio of home treatment period (period at home/period of survival), safety, medical cost and responses to a questionnaire survey of the patients about QOL. Results: The rate of effectiveness was 17%. In total, 83% of the patients did not show any serious clinical side effects prior to Progressive Disease. The average interval until Progressive Disease was 8 months. The ratio of home treatment period was 75%. The following toxicities were observed.: pigmentation of fingers (11 cases), cheilosis, aphtha (5 cases) nausea, vomiting (3 cases) leucocytopenia, grade 2 (10 cases). The toxicities described above were not severe. Catheter problems were observed in 7 cases. One case required the exchange of the reservoir. Medical cost of outpatient or home chemotherapy ranged from one-fourth to one-fifth of the cost of in-hospital chemotherapy. Conclusion: We concluded that outpatient or home chemotherapy with reservoir can be applied to patients safely and reliably and was also useful for improving patient QOL and reducing medical expenses.