術前化学放射線療法を行い治癒切除した仙骨浸潤直腸癌の1例
症例は50歳台，女性．血便と体重減少を認め，当院受診．下部消化管内視鏡検査で直腸癌を認めCTで仙骨浸潤（S4以下）・側方リンパ節腫大を認めた．根治術は困難と考え，化学放射線療法（以下CRT）を行い，治癒切除を試みる方針とした．局所への放射線療法（4,500cGy/25回）とTS-1 100mg/dayを2投1休で2クール施行した．CRT終了約1カ月後のCTで腫瘍は縮小し，CRT終了約2カ月後に腹仙骨式直腸切断術・仙骨合併切除術を施行した．病理組織では高分化腺癌・粘液癌が少量残存していたが，大半は瘢痕による線維化であり，組織学的CRT効果はGrade2で剥離断端も陰性であった．治癒切除が困難な仙...
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| Published in | 日本臨床外科学会雑誌 Vol. 78; no. 3; pp. 552 - 557 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.78.552 |
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| Abstract | 症例は50歳台，女性．血便と体重減少を認め，当院受診．下部消化管内視鏡検査で直腸癌を認めCTで仙骨浸潤（S4以下）・側方リンパ節腫大を認めた．根治術は困難と考え，化学放射線療法（以下CRT）を行い，治癒切除を試みる方針とした．局所への放射線療法（4,500cGy/25回）とTS-1 100mg/dayを2投1休で2クール施行した．CRT終了約1カ月後のCTで腫瘍は縮小し，CRT終了約2カ月後に腹仙骨式直腸切断術・仙骨合併切除術を施行した．病理組織では高分化腺癌・粘液癌が少量残存していたが，大半は瘢痕による線維化であり，組織学的CRT効果はGrade2で剥離断端も陰性であった．治癒切除が困難な仙骨浸潤を有する進行直腸癌に対する術前CRTは，腫瘍縮小，down staging，根治切除率の向上，局所再発制御，周囲臓器の機能温存等の点から有用であり，選択すべき治療オプションの一つとなり得る． |
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| AbstractList | 症例は50歳台，女性．血便と体重減少を認め，当院受診．下部消化管内視鏡検査で直腸癌を認めCTで仙骨浸潤（S4以下）・側方リンパ節腫大を認めた．根治術は困難と考え，化学放射線療法（以下CRT）を行い，治癒切除を試みる方針とした．局所への放射線療法（4,500cGy/25回）とTS-1 100mg/dayを2投1休で2クール施行した．CRT終了約1カ月後のCTで腫瘍は縮小し，CRT終了約2カ月後に腹仙骨式直腸切断術・仙骨合併切除術を施行した．病理組織では高分化腺癌・粘液癌が少量残存していたが，大半は瘢痕による線維化であり，組織学的CRT効果はGrade2で剥離断端も陰性であった．治癒切除が困難な仙骨浸潤を有する進行直腸癌に対する術前CRTは，腫瘍縮小，down staging，根治切除率の向上，局所再発制御，周囲臓器の機能温存等の点から有用であり，選択すべき治療オプションの一つとなり得る． |
| Author | 安井, 七々子 岩川, 和秀 磯田, 健太 常光, 洋輔 稲垣, 優 岩垣, 博巳 |
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| References | 2) 川原洋平，寺田逸郎，寺井志郎他:術前化学放射線療法後に治癒切除し得た局所進行直腸癌の1例．癌と化療 2015;42:2330-2333 13) Yamada K, Ishizawa T, Niwa K, et al : Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 2002 ; 45 : 1078-1084 6) Gerard JP, Conroy T, Bonnetain F, et al : Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers : results of FFCD 9203. J Clin Oncol 2006 ; 24 : 4620-4625 4) 大腸癌研究会/編:大腸癌治療ガイドライン．医師用2014年版，金原出版，東京，2014，p36 8) Ngan SY, Burmeister B, Fisher RJ, et al : Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer : Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012 ; 30 : 3827-3833 12) Peeters KC, van de Velde CJ, Leer JW, et al : Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer : increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005 ; 23 : 6199-6206 15) Suzuki T, Sadahiro S, Fukasawa M, et al : Predictive factors of tumor shrinkage and histological regression in patients who received preoperative radiotherapy for rectal cancer. Jpn J Clin Oncol 2004 ; 34 : 740-746 5) Bosset JF, Collette L, Calais G, et al ; EORTC Radiotherapy Group Trial 22921 : Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006 ; 355 : 1114-1123 18) Debucquoy A, Goethals L, Geboes K, et al : Molecular responses of rectal cancer to preoperative chemoradiation. Radiother Oncol 2006 ; 80 : 172-177 1) Sadahiro S, Suzuki T, Ishikawa K, et al : Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years. Hepatogastroenterology 2003 ; 50 : 1362-1366 7) Bujko K, Nowacki MP, Nsierowska-Guttmejer A, et al : Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006 ; 93 : 1215-1223 19) 藤村祥一:仙骨部腫瘍の手術仙骨部腫瘍に対する全摘出術後の神経機能．脊椎脊髄ジャーナル 1995;8:353-360 17) Ishihara S, Iinuma H, Fukushima Y, et al : Radiation-induced apoptosis of peripheral blood lymphocytes is correlated with histological regression of rectal cancer in response to preoperative chemoradiotherapy. Ann Surg Oncol 2012 ; 19 : 1192-1198 10) Lim SB, Choi HS, Jeong SY, et al : Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 2008 ; 248 : 243-251 11) Tran CL, Udani S, Holt A, et al : Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg 2006 ; 192 : 873-877 14) 池田正孝，関本貢嗣，原口直紹他:直腸癌局所再発に対する外科治療（仙骨合併切除）．臨外 2014;69:1204-1210 9) NCCN Clinical Practice Guidelines in Oncology Rectal Cancer v.2. 2015, (Accessed June 18, 2016, at http://www.tri-kobe.org/nccn/guideline/colorectal/japanese/rectal.html 3) Nagasaki T, Akiyoshi T, Ueno M, et al : Laparoscopic abdominosacral resection for locally advanced primary rectal cancer after treatment with mFOLFOX6 plus bevacizumab, followed by preoperative chemoradiotherapy. Asian J Endosc Surg 2014 ; 7 : 52-55 16) Hida J, Yasutomi M, Maruyama T, et al : Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method : justification of total mesorectal excision. J Am Coll Surg 1997 ; 184 : 584-588 |
| References_xml | – reference: 19) 藤村祥一:仙骨部腫瘍の手術仙骨部腫瘍に対する全摘出術後の神経機能．脊椎脊髄ジャーナル 1995;8:353-360 – reference: 1) Sadahiro S, Suzuki T, Ishikawa K, et al : Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years. Hepatogastroenterology 2003 ; 50 : 1362-1366 – reference: 11) Tran CL, Udani S, Holt A, et al : Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg 2006 ; 192 : 873-877 – reference: 17) Ishihara S, Iinuma H, Fukushima Y, et al : Radiation-induced apoptosis of peripheral blood lymphocytes is correlated with histological regression of rectal cancer in response to preoperative chemoradiotherapy. Ann Surg Oncol 2012 ; 19 : 1192-1198 – reference: 3) Nagasaki T, Akiyoshi T, Ueno M, et al : Laparoscopic abdominosacral resection for locally advanced primary rectal cancer after treatment with mFOLFOX6 plus bevacizumab, followed by preoperative chemoradiotherapy. Asian J Endosc Surg 2014 ; 7 : 52-55 – reference: 13) Yamada K, Ishizawa T, Niwa K, et al : Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 2002 ; 45 : 1078-1084 – reference: 4) 大腸癌研究会/編:大腸癌治療ガイドライン．医師用2014年版，金原出版，東京，2014，p36 – reference: 6) Gerard JP, Conroy T, Bonnetain F, et al : Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers : results of FFCD 9203. J Clin Oncol 2006 ; 24 : 4620-4625 – reference: 8) Ngan SY, Burmeister B, Fisher RJ, et al : Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer : Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012 ; 30 : 3827-3833 – reference: 12) Peeters KC, van de Velde CJ, Leer JW, et al : Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer : increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005 ; 23 : 6199-6206 – reference: 9) NCCN Clinical Practice Guidelines in Oncology Rectal Cancer v.2. 2015, (Accessed June 18, 2016, at http://www.tri-kobe.org/nccn/guideline/colorectal/japanese/rectal.html) – reference: 15) Suzuki T, Sadahiro S, Fukasawa M, et al : Predictive factors of tumor shrinkage and histological regression in patients who received preoperative radiotherapy for rectal cancer. Jpn J Clin Oncol 2004 ; 34 : 740-746 – reference: 10) Lim SB, Choi HS, Jeong SY, et al : Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 2008 ; 248 : 243-251 – reference: 18) Debucquoy A, Goethals L, Geboes K, et al : Molecular responses of rectal cancer to preoperative chemoradiation. Radiother Oncol 2006 ; 80 : 172-177 – reference: 5) Bosset JF, Collette L, Calais G, et al ; EORTC Radiotherapy Group Trial 22921 : Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006 ; 355 : 1114-1123 – reference: 7) Bujko K, Nowacki MP, Nsierowska-Guttmejer A, et al : Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006 ; 93 : 1215-1223 – reference: 2) 川原洋平，寺田逸郎，寺井志郎他:術前化学放射線療法後に治癒切除し得た局所進行直腸癌の1例．癌と化療 2015;42:2330-2333 – reference: 16) Hida J, Yasutomi M, Maruyama T, et al : Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method : justification of total mesorectal excision. J Am Coll Surg 1997 ; 184 : 584-588 – reference: 14) 池田正孝，関本貢嗣，原口直紹他:直腸癌局所再発に対する外科治療（仙骨合併切除）．臨外 2014;69:1204-1210 |
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| Snippet | 症例は50歳台，女性．血便と体重減少を認め，当院受診．下部消化管内視鏡検査で直腸癌を認めCTで仙骨浸潤（S4以下）・側方リンパ節腫大を認めた．根治術は困難と考え，化... |
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| SubjectTerms | 仙骨合併切除 直腸癌仙骨浸潤 術前化学放射線療法 |
| Title | 術前化学放射線療法を行い治癒切除した仙骨浸潤直腸癌の1例 |
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