通常型膵癌に対する術前化学放射線療法にてpCRを得たが肺再発を来した一例  [in Japanese] Pulmonary recurrence of pancreatic ductal carcinoma in a patient with pathological complete response to preoperative chemoradiation therapy: a case report  [in Japanese]

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Author(s)

    • 佐々木 一樹 SASAKI Kazuki
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 丸橋 繁 MARUBASHI Shigeru
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 能浦 真吾 NOURA Shingo
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 大植 雅之 OHUE Masayuki
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 矢野 雅彦 YANO Masahiko
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 左近 賢人 SAKON Masato
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 石川 治 ISHIKAWA Osamu
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 秋田 裕史 AKITA Hirofumi
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 大東 弘明 OHIGASHI Hiroaki
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 三吉 範克 MIYOSHI Norikatsu
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 本告 正明 MOTOORI Masaaki
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 後藤 邦仁 GOTOH Kunihito
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
    • 岸 健太郎 KISHI Kentaro
    • 大阪府立成人病センター消化器外科 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases

Abstract

60代女性.背部痛を主訴に受診し,精査にて膵体尾部癌(径15mm,cT4N0M0 cStage IVa)と診断された.術前化学放射線療法(gemcitabine 1000mg/m<sup>2</sup>,50Gy/25Fr)施行後,膵体尾部切除術,及び,術後肝潅流化学療法(LPC:gemcitabine 600mg/body×4回)を施行した.病理組織診断ではpCRであった.膵切除後30ヶ月目に右肺S8に22mm大の腫瘤影を認め,膵癌肺転移(Adenocarcinoma)と診断された.全身検索にて局所・肝などに再発を認めなかったので,胸腔鏡補助下右肺下葉部分切除を施行した(膵切除後33ヶ月).しかし肺切除後5ヶ月で縦隔リンパ節再発・胸膜播種を合併し,膵切除後47ヶ月,肺切除後14ヶ月で原病死した.進行膵癌は潜在的systemic diseaseであることを踏まえた治療戦略が必要である.<br>

A 66-year-old female patient with resectable pancreatic body cancer had previously received the preoperative gemcitabine-based chemoradiation therapy and a subsequent distal pancreatectomy combined with liver perfusion chemotheprapy. Histopathological assessment of the resected specimen revealed no viable tumor cells (pathological complete response). She received the scheduled postoperative follow-up, and revealed a tumor in the upper lobe of right lung 30 months after the initial pancreatectomy. Because of the absence of the recurrence of pancreatic cancer in sites other than the right lung, the patient underwent a partial resection of the right upper lobe. The diagnosis of the lung metastasis originated from pancreatic cancer was confirmed based on histological as well as immunohistopathological assessments. The patient developed tumor recurrences in mediastinal lymph nodes and carcinomatous pleuritis 6 months after the second surgery, and died 47 months after the initial pancreatectomy and 14 months after the second surgery for the lung metastasis. This case indicates the pathophysiology of a systemic disease even in the case of <i>localized</i> pancreatic cancer, and thus, the therapeutic strategy, based on the fact that the pancreatic cancer is potentially a systemic disease, is needed to improve the surgical outcome of advanced pancreatic cancer.<br>

Journal

  • Suizo

    Suizo 29(2), 234-240, 2014

    Japan Pancreas Society

Codes

  • NII Article ID (NAID)
    130004496071
  • Text Lang
    JPN
  • ISSN
    0913-0071
  • Data Source
    J-STAGE 
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