S-1療法を中心とした集学的治療により病理学的完全寛解が得られた肝転移を伴う膵頭部癌の1例
症例は58歳の男性で，CTで上腸間膜動脈に180°未満の浸潤を疑う切除可能境界膵頭部癌の診断で紹介となり，術前化学放射線療法（neoadjuvant chemoradiation therapy；以下，NACRTと略記）（S-1（120 mg/day 4投2休1クール），RT 50.4 Gy/28日）を施行した．NACRT後，画像の効果判定は有効であったが，動脈浸潤部の所見は不変であった．開腹手術に臨んだが，1か所の肝転移を認め試験開腹術とした．術後はS-1療法を継続し，7クール後，腫瘍はさらに縮小し，新規病変も認めなかったため，膵頭十二指腸切除術を施行した．組織学的治療効果判定はGrade...
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| Published in | 日本消化器外科学会雑誌 Vol. 50; no. 6; pp. 461 - 468 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.2016.0122 |
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| Abstract | 症例は58歳の男性で，CTで上腸間膜動脈に180°未満の浸潤を疑う切除可能境界膵頭部癌の診断で紹介となり，術前化学放射線療法（neoadjuvant chemoradiation therapy；以下，NACRTと略記）（S-1（120 mg/day 4投2休1クール），RT 50.4 Gy/28日）を施行した．NACRT後，画像の効果判定は有効であったが，動脈浸潤部の所見は不変であった．開腹手術に臨んだが，1か所の肝転移を認め試験開腹術とした．術後はS-1療法を継続し，7クール後，腫瘍はさらに縮小し，新規病変も認めなかったため，膵頭十二指腸切除術を施行した．組織学的治療効果判定はGrade 4であった．術後はS-1による補助療法を施行し，現在，24か月無再発生存中である．近年，化学療法の進歩により，切除不能膵癌が画像上切除可能となる症例が散見される．本症例のように，切除を行い良好な成績が得られる症例もあるが，手術の適応や時期には一定の見解はなく，今後の症例集積が重要である． |
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| AbstractList | 症例は58歳の男性で，CTで上腸間膜動脈に180°未満の浸潤を疑う切除可能境界膵頭部癌の診断で紹介となり，術前化学放射線療法（neoadjuvant chemoradiation therapy；以下，NACRTと略記）（S-1（120 mg/day 4投2休1クール），RT 50.4 Gy/28日）を施行した．NACRT後，画像の効果判定は有効であったが，動脈浸潤部の所見は不変であった．開腹手術に臨んだが，1か所の肝転移を認め試験開腹術とした．術後はS-1療法を継続し，7クール後，腫瘍はさらに縮小し，新規病変も認めなかったため，膵頭十二指腸切除術を施行した．組織学的治療効果判定はGrade 4であった．術後はS-1による補助療法を施行し，現在，24か月無再発生存中である．近年，化学療法の進歩により，切除不能膵癌が画像上切除可能となる症例が散見される．本症例のように，切除を行い良好な成績が得られる症例もあるが，手術の適応や時期には一定の見解はなく，今後の症例集積が重要である． |
| Author | 上村, 直 山本, 有祐 蘆田, 良 上坂, 克彦 伊藤, 貴明 宮田, 隆司 岡村, 行泰 杉浦, 禎一 |
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| Copyright | 2017 一般社団法人 日本消化器外科学会 |
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| References | 7) Cunningham D, Chau I, Stocken DD, Valle JW, Smith D, Steward W, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol. 2009;27:5513–5518. 10) Kato K, Kondo S, Hirano S, Tanaka E, Shichinohe T, Tsuchikawa T, et al. Adjuvant surgical therapy for patients with initially-unresectable pancreatic cancer with long-term favorable responses to chemotherapy. J Hepatobiliary Pancreat Sci. 2011;18:712–716. 22) 日本膵臓学会編．膵癌取扱い規約．第6版補訂版．東京：金原出版；2013. p. 10. 14) Nakai Y, Isayama H, Sasaki T, Takahara N, Hamada T, Uchino R, et al. A retrospective analysis of early CAl9-9 change in salvage chemotherapy for refractory pancreatic cancer. Cancer Chemother Pharmacol. 2013;72:1291–1297 15) Takahashi H, Ohigashi H, Ishikawa O, Eguchi H, Gotoh K, Yamada T, et al. Serum CA19-9 alterations during preoperative gemcitabine-based chemoradiation therapy for resectable invasive ductal carcinoma of the pancreas as an indicator for therapeutic selection and survival. Ann Surg. 2010;251:461–469. 8) Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–1825. 24) Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–1703. 23) 蔵原 弘，前村 公成，又木 雄弘，迫田 雅彦，飯野 聡，樋渡 清司，ほか．傍大動脈リンパ節転移を伴うcStage IVb膵癌に対してS-1+gemcitabine療法により組織学的CRが得られた1例．膵臓．2014;29:898–904. 6) Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–2413 1) Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992;326:455–465. 13) 又木 雄弘，高尾 尊身，前村 公成，蔵原 弘，新地 洋之，夏越 群次．膵癌の化学・放射線療法の評価におけるFDG-PETの役割．胆と膵．2012;33:421–426. 20) Choi M, Heilbrun LK, Venkatramanamoorthy R, Lawhorn-Crews JM, Zalupski MM, Shields AF. Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer. Am J Clin Oncol. 2010;33:257–261 2) 日本膵臓学会編．膵癌取扱い規約．第7版．東京：金原出版；2016. p. 2–8. 19) Kittaka H, Takahashi H, Ohigashi H, Gotoh K, Yamada T, Tomita Y, et al. Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting the pathologic response to preoperative chemoradiation therapy in patients with resectable T3 pancreatic cancer. World J Surg. 2013;37:169–178 12) Yoshioka M, Sato T, Furuya T, Shibata S, Andoh H, Asanuma Y, et al. Role of positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose in evaluating the effects of arterial infusion chemotherapy and radiotherapy on pancreatic cancer. J Gastroenterol. 2004;39:50–55 16) 高橋 秀典，秋田 裕史，後藤 邦仁，丸橋 繁，大東 弘明，矢野 雅彦，ほか．局所進行膵癌に対する術前化学放射線療法における治療効果予測・予後予測の検討．胆と膵．2014;35:73–79. 17) Ziske C, Schlie C, Gorschlüter M, Glasmacher A, Mey U, Strehl J, et al. Prognostic value of CA19-9 1evels in patients with inoperable adenocarcinoma of the pancreas treated with gemcitabine. Br J Cancer. 2003;89:1413–1417 18) Stemmler J, Stieber P, Szymale AM, Schalhorn A, Schermuly MM, Wilkowski R, et al. Are serial CA19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin? Onkologie. 2003;26:462–467 4) 江川 新一，当間 宏樹，大東 弘明，奥坂 拓志，中尾 昭公，羽鳥 隆，ほか．膵癌登録報告2007 ダイジェスト．膵臓．2008;23:105–123 9) Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–1648. 3) Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467:1114–1117. 5) Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–1966. 11) 佐藤 良平，滝沢 一泰，油座 築，相馬 大輝，廣瀬 雄己，森本 悠太，ほか．化学放射線療法にて根治切除し得た局所進行切除不能膵癌の1例．癌と化学療法．2015;42:2385–2387. 21) Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20:590–600 |
| References_xml | – reference: 10) Kato K, Kondo S, Hirano S, Tanaka E, Shichinohe T, Tsuchikawa T, et al. Adjuvant surgical therapy for patients with initially-unresectable pancreatic cancer with long-term favorable responses to chemotherapy. J Hepatobiliary Pancreat Sci. 2011;18:712–716. – reference: 5) Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–1966. – reference: 3) Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467:1114–1117. – reference: 9) Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–1648. – reference: 6) Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–2413． – reference: 14) Nakai Y, Isayama H, Sasaki T, Takahara N, Hamada T, Uchino R, et al. A retrospective analysis of early CAl9-9 change in salvage chemotherapy for refractory pancreatic cancer. Cancer Chemother Pharmacol. 2013;72:1291–1297． – reference: 16) 高橋 秀典，秋田 裕史，後藤 邦仁，丸橋 繁，大東 弘明，矢野 雅彦，ほか．局所進行膵癌に対する術前化学放射線療法における治療効果予測・予後予測の検討．胆と膵．2014;35:73–79. – reference: 15) Takahashi H, Ohigashi H, Ishikawa O, Eguchi H, Gotoh K, Yamada T, et al. Serum CA19-9 alterations during preoperative gemcitabine-based chemoradiation therapy for resectable invasive ductal carcinoma of the pancreas as an indicator for therapeutic selection and survival. Ann Surg. 2010;251:461–469. – reference: 12) Yoshioka M, Sato T, Furuya T, Shibata S, Andoh H, Asanuma Y, et al. Role of positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose in evaluating the effects of arterial infusion chemotherapy and radiotherapy on pancreatic cancer. J Gastroenterol. 2004;39:50–55． – reference: 13) 又木 雄弘，高尾 尊身，前村 公成，蔵原 弘，新地 洋之，夏越 群次．膵癌の化学・放射線療法の評価におけるFDG-PETの役割．胆と膵．2012;33:421–426. – reference: 21) Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20:590–600． – reference: 17) Ziske C, Schlie C, Gorschlüter M, Glasmacher A, Mey U, Strehl J, et al. Prognostic value of CA19-9 1evels in patients with inoperable adenocarcinoma of the pancreas treated with gemcitabine. Br J Cancer. 2003;89:1413–1417． – reference: 18) Stemmler J, Stieber P, Szymale AM, Schalhorn A, Schermuly MM, Wilkowski R, et al. Are serial CA19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin? Onkologie. 2003;26:462–467． – reference: 20) Choi M, Heilbrun LK, Venkatramanamoorthy R, Lawhorn-Crews JM, Zalupski MM, Shields AF. Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer. Am J Clin Oncol. 2010;33:257–261． – reference: 23) 蔵原 弘，前村 公成，又木 雄弘，迫田 雅彦，飯野 聡，樋渡 清司，ほか．傍大動脈リンパ節転移を伴うcStage IVb膵癌に対してS-1+gemcitabine療法により組織学的CRが得られた1例．膵臓．2014;29:898–904. – reference: 2) 日本膵臓学会編．膵癌取扱い規約．第7版．東京：金原出版；2016. p. 2–8. – reference: 7) Cunningham D, Chau I, Stocken DD, Valle JW, Smith D, Steward W, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol. 2009;27:5513–5518. – reference: 4) 江川 新一，当間 宏樹，大東 弘明，奥坂 拓志，中尾 昭公，羽鳥 隆，ほか．膵癌登録報告2007 ダイジェスト．膵臓．2008;23:105–123． – reference: 1) Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992;326:455–465. – reference: 8) Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–1825. – reference: 22) 日本膵臓学会編．膵癌取扱い規約．第6版補訂版．東京：金原出版；2013. p. 10. – reference: 24) Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–1703. – reference: 11) 佐藤 良平，滝沢 一泰，油座 築，相馬 大輝，廣瀬 雄己，森本 悠太，ほか．化学放射線療法にて根治切除し得た局所進行切除不能膵癌の1例．癌と化学療法．2015;42:2385–2387. – reference: 19) Kittaka H, Takahashi H, Ohigashi H, Gotoh K, Yamada T, Tomita Y, et al. Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting the pathologic response to preoperative chemoradiation therapy in patients with resectable T3 pancreatic cancer. World J Surg. 2013;37:169–178． |
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| Snippet | 症例は58歳の男性で，CTで上腸間膜動脈に180°未満の浸潤を疑う切除可能境界膵頭部癌の診断で紹介となり，術前化学放射線療法（neoadjuvant chemoradiation therapy；以下，NACRTと略記）（S-1（120 mg/day 4投2休1クール），RT 50.4... |
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| SubjectTerms | S-1療法 完全寛解 膵癌肝転移 |
| Title | S-1療法を中心とした集学的治療により病理学的完全寛解が得られた肝転移を伴う膵頭部癌の1例 |
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| ispartofPNX | 日本消化器外科学会雑誌, 2017/06/01, Vol.50(6), pp.461-468 |
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