<sup>31</sup>P Magnetic resonance spectroscopy (<sup>31</sup>P MRS) による治療効果の早期判定の試み:胸壁腫瘤を形成した前立腺癌骨転移の1例 MONITORING TUMOR RESPONSE TO THERAPY BY MEANS OF <sup>31</sup>P MAGNETIC RESONANCE SPECTROSCOPY:A Case of Advanced Prostatic Cancer with Metastatic Chest Wall Tumor

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内分泌療法に抵抗性となった Stage D<sub>2</sub>前立腺癌例に対し, diethylstilbestrol diphosphate (DESP) の大量投与療法を行うにあたり, <sup>31</sup>P magnetic resonance spectroscopy (<sup>31</sup>P MRS) による治療効果の早期判定の可能性を検討した. 症例は83歳男性で1984年3月初診. 除睾術を施行後, chlormadinon acetate 及び cyclophosphamide を中心とした内服治療で経過観察をしていた. 1991年12月頃より腫瘍マーカーの再上昇があり, 1992年4月貧血と右胸壁腫瘤が認められ, 5月6日当科に入院した. 胸壁の腫瘤は生検の結果, 前立腺癌の肋骨転移と診断され, 6月11日よりDESP500mg/日の点滴静注を開始した. 初回投与4時間後の<sup>31</sup>P MRSで, 高周波領域成分の広範囲な増加とともに, phosphodiesters (PDE), phosphomonoesters (PME) のピークの増高が認められ, すでに治療に反応して腫瘍の細胞に変化が生じていることが示唆された. 同様の所見はその後も継続して観察され, 細胞の破壊が進んでいるものと思われた. 臨床的には10日目頃より腫瘤の縮小が認められ, 腫瘍マーカーも低下して治療の効果が確認された. 以上の結果から, <sup>31</sup>P MRSは臨床所見や画像診断に先んじて治療の有効性を早期に判定できる可能性が考えられた.

The response of advanced prostatic cancer with metastatic chest wall tumor to high-dose diethylstilbestrol diphosphate (DESP) therapy was monitored by in vivo <sup>31</sup>P magnetic resonance spectroscopy (<sup>31</sup>P MRS) study.<br>A eighty-three year old man with Stage D<sub>2</sub> prostatic cancer had been treated with chlormadinone acetate and cyclophosphamide since 1984. He was admitted to our hospital with a chest wall tumor and anemia on May 9, 1992. The elavated PAP, PSA and γ-Sm levels were also observed. Needle biopsy of the tumor revealed poorly differentiated adenocarcinoma metastatic from the prostatic cancer. The patient received 500mg of DESP by DIV daily for 10 days, and the tumor was reduced by 54% clinically.<br>The abnormal PAP, PSA and γ-Sm levels returned to almost normal range by three weeks after the initiation of high-dose DESP therapy, and regression of the tumor was confirmed by the MRI. After the first administration of DESP, the MR spectra of the chest wall tumor showed elavated peaks of phosphomonoesters and phosphodiesters. These substances are related to the membrane metabolism and their increase represents the membranous degeneration of tumor cells. The same changes continued consecuitively for three weeks, and corresponded with the regression of the tumor.<br>In conclusion, these results suggest that in vivo <sup>31</sup>P MRS of malignant tumors can be useful for evaluating early response to therapy prior to other clinical examinations.


  • The Japanese Journal of Urology

    The Japanese Journal of Urology 85(5), 819-822, 1994

    The Japanese Urological Association

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