膵がん術後の頭蓋骨転移による頭痛に対し緩和的放射線治療が奏効した1例

【緒言】膵がんの再発形式は局所再発や腹膜播種が多く，強い腹痛や背部痛の原因となる．今回，膵がん術後の頭蓋骨転移により頭痛をきたし，放射線治療が有効だった症例を経験した．【症例】67歳女性．膵がん術後，局所再発と腹膜播種による心窩部痛に対し，ロキソプロフェンとフェンタニル貼付剤でコントロールが得られていた．右頭痛が出現し徐々に増強したが頭蓋内圧亢進症状や巣症状に乏しく，一次性頭痛が疑われた．頭痛に対するアセトアミノフェンや五苓散の効果は乏しかった．CTでは脳転移や骨転移を認めなかったが，MRIで右前頭骨に転移を認めた．同部位に対し緩和的放射線治療を施行した．頭痛はNumerical Rating...

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Published inPalliative Care Research Vol. 19; no. 1; pp. 41 - 46
Main Authors 山田, 健介, 苅田, 雅子, 眞鍋, 裕気, 中尾, 光宏, 吉川, 功一, 水田, 英司, 田中, 秀和, 佐藤, 智充, 貞廣, 浩和
Format Journal Article
LanguageJapanese
Published 日本緩和医療学会 2024
Subjects
放射線治療
膵がん
頭痛
頭蓋骨転移
Online AccessGet full text
ISSN1880-5302
DOI10.2512/jspm.19.41

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Abstract 【緒言】膵がんの再発形式は局所再発や腹膜播種が多く，強い腹痛や背部痛の原因となる．今回，膵がん術後の頭蓋骨転移により頭痛をきたし，放射線治療が有効だった症例を経験した．【症例】67歳女性．膵がん術後，局所再発と腹膜播種による心窩部痛に対し，ロキソプロフェンとフェンタニル貼付剤でコントロールが得られていた．右頭痛が出現し徐々に増強したが頭蓋内圧亢進症状や巣症状に乏しく，一次性頭痛が疑われた．頭痛に対するアセトアミノフェンや五苓散の効果は乏しかった．CTでは脳転移や骨転移を認めなかったが，MRIで右前頭骨に転移を認めた．同部位に対し緩和的放射線治療を施行した．頭痛はNumerical Rating Scaleで7–8/10から2–3/10に軽減した．【結論】がん患者の頭蓋骨転移がCTでは診断できず，MRIで診断できることがある．
AbstractList 【緒言】膵がんの再発形式は局所再発や腹膜播種が多く，強い腹痛や背部痛の原因となる．今回，膵がん術後の頭蓋骨転移により頭痛をきたし，放射線治療が有効だった症例を経験した．【症例】67歳女性．膵がん術後，局所再発と腹膜播種による心窩部痛に対し，ロキソプロフェンとフェンタニル貼付剤でコントロールが得られていた．右頭痛が出現し徐々に増強したが頭蓋内圧亢進症状や巣症状に乏しく，一次性頭痛が疑われた．頭痛に対するアセトアミノフェンや五苓散の効果は乏しかった．CTでは脳転移や骨転移を認めなかったが，MRIで右前頭骨に転移を認めた．同部位に対し緩和的放射線治療を施行した．頭痛はNumerical Rating Scaleで7–8/10から2–3/10に軽減した．【結論】がん患者の頭蓋骨転移がCTでは診断できず，MRIで診断できることがある．
Author 水田, 英司
佐藤, 智充
山田, 健介
貞廣, 浩和
吉川, 功一
眞鍋, 裕気
田中, 秀和
中尾, 光宏
苅田, 雅子
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References 2） Crippa S, Belfiori G, Bissolati M, et al. Recurrence after surgical resection of pancreatic cancer: the importance of postoperative complications beyond tumor biology. HPB (Oxford) 2021; 23: 1666–73.
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8） Greenberg HS, Deck MD, Vikram B, et al. Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 1981; 31: 530–7.
9） Yang HL, Liu T, Wang XM, et al. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 2011; 21: 2604–17.
4） Mitsuya K, Nakasu Y, Horiguchi S, et al. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol 2011; 104: 239–45.
References_xml – reference: 12） Palmedo H, Marx C, Ebert A, et al. Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients. Eur J Nucl Med Mol Imaging 2014; 41: 59–67.
– reference: 9） Yang HL, Liu T, Wang XM, et al. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 2011; 21: 2604–17.
– reference: 4） Mitsuya K, Nakasu Y, Horiguchi S, et al. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol 2011; 104: 239–45.
– reference: 13） 日本脳腫瘍学会，成人転移性脳腫瘍，日本脳腫瘍学会 編．脳腫瘍診療ガイドライン2019年版．金原出版，東京，2019; 59–106.
– reference: 5） Aydin VM, Cekinmez M, Kizilkilic O, et al. Unusual case of skull metastasis secondary to pancreatic adenocarcinoma. Pathol Oncol Res 2005; 11: 182–3.
– reference: 7） Jones RP, Psarelli E, Jackson R, et al.; European Study Group for Pancreatic Cancer. Patterns of recurrence after resection of pancreatic ductal adenocarcinoma: a secondary analysis of the ESPAC-4 randomized adjuvant chemotherapy trial. JAMA Surg 2019; 154: 1038–48.
– reference: 10） Bruckmann NM, Kirchner J, Umutlu L, et al. Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Eur Radiol 2021; 31: 8714–24.
– reference: 8） Greenberg HS, Deck MD, Vikram B, et al. Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 1981; 31: 530–7.
– reference: 14） Vikram B, Chu FC. Radiation therapy for metastases to the base of the skull. Radiology 1979; 130: 465–8.
– reference: 6） Igarashi M, Card GG, Johnson PE, et al. Bilateral sudden hearing loss and metastatic pancreatic adenocarcinoma. Arch Otolaryngol 1979; 105: 196–9.
– reference: 3） Habermehl D, Brecht IC, Debus J, et al. Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group. Eur J Med Res 2014; 19: 24.
– reference: 11） Yasumizu Y, Kosaka T, Hongo H, et al. Cranial nerve palsy caused by metastasis to the skull base in patients with castration-resistant prostate cancer: Three case reports. IJU Case Rep 2021; 4: 108–11.
– reference: 1） Ratnayake B, Savastyuk AY, Nayar M, et al. Recurrence patterns for pancreatic ductal adenocarcinoma after upfront resection versus resection following neoadjuvant therapy: a comprehensive meta-analysis. J Clin Med 2020; 9: 2132.
– reference: 2） Crippa S, Belfiori G, Bissolati M, et al. Recurrence after surgical resection of pancreatic cancer: the importance of postoperative complications beyond tumor biology. HPB (Oxford) 2021; 23: 1666–73.
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SubjectTerms 放射線治療
膵がん
頭痛
頭蓋骨転移
Title 膵がん術後の頭蓋骨転移による頭痛に対し緩和的放射線治療が奏効した1例
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