維持透析患者に発症した進行膵癌にゲムシタビン単独化学療法を施行した1例 Successful management for unresectable pancreatic cancer with chronic liver failure treated by gemcitabine and hemodialysis

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著者

    • 吉田 雅博 YOSHIDA Masahiro
    • 化学療法研究所附属病院人工透析センター・一般外科 Department of Hemodialysis and Surgery, Chemotherapy Research Institute, Kaken Hospital
    • 鵜梶 実 UKAJI Minoru
    • 化学療法研究所附属病院人工透析センター消化器内科 Department of Gastroenterology, Chemotherapy Research Institute, Kaken Hospital
    • 税所 宏光 SAISHO Hiromitsu
    • 化学療法研究所附属病院人工透析センター消化器内科 Department of Gastroenterology, Chemotherapy Research Institute, Kaken Hospital

抄録

症例は69歳男性.糖尿病性慢性腎不全により,2008年7月に透析を導入し,近医にて維持透析(2回/週:火,土)を受けていた.定期腹部超音波にて膵尾部癌+多発性肝転移の診断を受けた.2009年4月に当院紹介入院,血液透析併施ゲムシタビン単独療法施行を開始した.月曜午後にゲムシタビン(1000mg/m<sup>2</sup>×3投1休)投与し,火,土の透析計画とした.ゲムシタビン投与直後から有害事象がみられ,投与間隔の延長や休薬,投与量の変更を余儀なくされた.著しい貧血や血圧低下のためにシャント不全に対するPTAや輸血の対応が必要となった.治療開始後1.5ヵ月のCTにてStable Disease(SD)の判定,CA19-9の低下を認め,外来通院にて治療継続となった.その後本人および家族との協力の下で治療継続し,2010年6月に永眠された.文献的考察を含め報告する.<br>

A 69-year-old male with chronic renal failure, due to diabetic nephropathy, had received maintenance dialysis (twice/week) since July 2008. Multiple liver tumors were seen in routine abdominal ultrasound, and diagnosed as carcinoma of tail of pancreas with multiple liver metastases on CT. The patient was admitted to the Gastroenterology unit of our hospital in April 2009, and single GEM chemotherapy was started together with hemodialysis. Gemcitabine (1000mg/m<sup>2</sup>×3 times/month) was given on Monday evening, and hemodialysis was performed on Tuesday and Saturday to remove gemcitabine metabolites. Extension of dosage interval, dosage adjustment, and drug withdrawal were required due to pancytopenia and fever occurring after the administration of gemcitabine. Furthermore, blood transfusion and percutaneous transluminal angioplasty (PTA) were given for shunt failure due to severe anemia and low blood pressure. One and a half months after treatment, CT showed stable disease (SD) and also there was reduction in serum CA19-9, the patient was discharged from hospital and continued treatment as outpatient follow-up till June 2010, when the patient expired. Although there is continued hemodialysis in patients due to an increase in aging populations and lifestyle related diseases, reports on antineoplastic agents are still very rare.<br>

収録刊行物

  • 膵臓 = The Journal of Japan Pancreas Society

    膵臓 = The Journal of Japan Pancreas Society 27(2), 199-205, 2012-04-25

    日本膵臓学会

参考文献:  17件中 1-17件 を表示

各種コード

  • NII論文ID(NAID)
    10030764184
  • NII書誌ID(NCID)
    AN10043798
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    09130071
  • データ提供元
    CJP書誌  J-STAGE 
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