胃癌術後癌性髄膜炎に対して髄腔内化学療法が症状コントロールに有用だった1例  [in Japanese] A case of meningeal carcinomatosis due to gastric cancer treated with intrathecal chemotherapy  [in Japanese]

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Abstract

症例は71歳男性.前庭部2型胃癌に対して幽門側胃切除を施行,腹膜播種陽性に対して化学療法を行っていたが,術後2年目に頭痛を主訴とする癌性髄膜炎再発をきたした.ステロイド,鎮痛剤に抵抗性であったが,MTX・Ara-Cの髄腔内投与で症状が改善し,3カ月間の在宅管理が可能であった.胃癌の生存延長とともにまれとされていた再発形式が増加しているが,治療法は定まっておらず,局所・全身化学療法を組み合わせた治療法の開発が必要である.<br>

A 71-year-old man was admitted to our hospital in September 2009 because of severe headache due to meningeal carcinomatosis. In July 2007, subtotal gastrectomy was carried out for gastric cancer. Because intraabdominal cytodiagnosis was positive, he received systemic chemotherapy for 2 years. Recurrent signs were not found on chest or abdominal CT just before hospitalization. He was given NSAIDs and corticosteroid, but his symptom did not improve. Subsequent intrathecal chemotherapy with MTX and Ara-C improved clinical symptoms dramatically. He received care at home for 3 months before he passed away due to pleural and peritoneal recurrence. Recently, since the frequency of meningeal carcinomatosis is increasing, combination treatment of intrathecal chemotherapy and systemic chemotherapy should be considered not only for improvement of clinical manifestations, but also for prognostic improvement.<br>

Journal

  • Nippon Shokakibyo Gakkai Zasshi

    Nippon Shokakibyo Gakkai Zasshi 108(10), 1696-1704, 2011-10-05

    The Japanese Society of Gastroenterology

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