縦隔原発悪性胚細胞性腫瘍に対するBEP療法中に発症した間質性肺炎治療後に手術を施行した2例
ブレオマイシンによる間質性肺炎は総投与量依存性に頻度が増加する．高容量投与が必要となる縦隔胚細胞性腫瘍において，治療中に間質性肺炎を生じた場合は，その後の手術にも影響がおよぶ可能性がある．今回BEP（bleomycin＋etoposide＋cisplatin）療法中に生じた間質性肺炎を治療し，早期に手術を施行した2例を報告する．症例1は19歳の男性，症例2は24歳男性で，ともに前縦隔に約10 cmの腫瘍を認め，針生検で卵黄囊腫瘍と診断された．BEP療法を開始し，それぞれ，ブレオマイシン総投与量360，330 mgで間質性肺炎を発症した．化学療法開始103日目，109日目から3日間のステロイドパ...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 31; no. 1; pp. 109 - 114 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器外科学会
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.31.109 |
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| Abstract | ブレオマイシンによる間質性肺炎は総投与量依存性に頻度が増加する．高容量投与が必要となる縦隔胚細胞性腫瘍において，治療中に間質性肺炎を生じた場合は，その後の手術にも影響がおよぶ可能性がある．今回BEP（bleomycin＋etoposide＋cisplatin）療法中に生じた間質性肺炎を治療し，早期に手術を施行した2例を報告する．症例1は19歳の男性，症例2は24歳男性で，ともに前縦隔に約10 cmの腫瘍を認め，針生検で卵黄囊腫瘍と診断された．BEP療法を開始し，それぞれ，ブレオマイシン総投与量360，330 mgで間質性肺炎を発症した．化学療法開始103日目，109日目から3日間のステロイドパルスを行い，その後内服で維持療法を行った．画像上，間質性肺炎の改善を認めたため，手術はパルス療法開始後17日目と26日目に残存腫瘍切除と肺部分切除を行った．ともに術後呼吸不全の発症なく経過良好であった． |
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| AbstractList | ブレオマイシンによる間質性肺炎は総投与量依存性に頻度が増加する．高容量投与が必要となる縦隔胚細胞性腫瘍において，治療中に間質性肺炎を生じた場合は，その後の手術にも影響がおよぶ可能性がある．今回BEP（bleomycin＋etoposide＋cisplatin）療法中に生じた間質性肺炎を治療し，早期に手術を施行した2例を報告する．症例1は19歳の男性，症例2は24歳男性で，ともに前縦隔に約10 cmの腫瘍を認め，針生検で卵黄囊腫瘍と診断された．BEP療法を開始し，それぞれ，ブレオマイシン総投与量360，330 mgで間質性肺炎を発症した．化学療法開始103日目，109日目から3日間のステロイドパルスを行い，その後内服で維持療法を行った．画像上，間質性肺炎の改善を認めたため，手術はパルス療法開始後17日目と26日目に残存腫瘍切除と肺部分切除を行った．ともに術後呼吸不全の発症なく経過良好であった． |
| Author | 滝沢, 宏光 広瀬, 敏幸 先山, 正二 鳥羽, 博明 河北, 直也 |
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| References | 4. Schneider BP, Kesler KA, Brooks JA, Yiannoutsos C, Einhorn LH. Outcome of patients with residual germ cell or non-germ cell malignancy after resection of primary mediastinal nonseminomatous germ cell cancer. J Clin Oncol 2004; 22: 1195-200. 11. Goldiner PL, Carlon GC, Cvitkovic E, Schweizer O, Howland WS. Factors influencing postoperative morbidity and mortality in patients treated with bleomycin. Br Med J 1978; 1: 1664-7. 2. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15: 594-603. 12. Donat SM. Peri-operative care in patients treated for testicular cancer. Semin Surg Oncol 1999; 17: 282-8. 3. Vuky J, Bains M, Bacik J, Higgins G, Bajorin DF, Mazumdar M, et al. Role of postchemotherapy adjunctive surgery in the management of patients with nonseminoma arising from the mediastinum. J Clin Oncol 2001; 19: 682-8. 8. Kuwano H, Tsuchiya T, Murayama T, Sano A, Nagayama K, Yoshida Y, et al. Outcomes of combined modality therapy for patients with stage III or IV mediastinal malignant germ cell tumors. Surg Today 2014; 44: 499-504. 5. Nichols CR, Catalano PJ, Crawford ED, Vogelzang NJ, Einhorn LH, Loehrer PJ. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol 1998; 16: 1287-93. 9. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA 2002; 287: 236-40. 1. Comis RL. Bleomycin pulmonary toxicity: current status and future directions. Semin Oncol 1992; 19: 64-70. 10. Marik PE, Varon J. Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature. Arch Surg 2008; 143: 1222-6. 6. Kubo K, Azuma A, Kanazawa M, Kameda H, Kusumoto M, Genma A, et al. Consensus statement for the diagnosis and treatment of drug-induced lung injuries. Respir Investig 2013; 51: 260-77. 7. Kesler KA, Rieger KM, Hammoud ZT, Kruter LE, Perkins SM, Turrentine MW, et al. A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors. Ann Thorac Surg 2008; 85: 371-8. |
| References_xml | – reference: 8. Kuwano H, Tsuchiya T, Murayama T, Sano A, Nagayama K, Yoshida Y, et al. Outcomes of combined modality therapy for patients with stage III or IV mediastinal malignant germ cell tumors. Surg Today 2014; 44: 499-504. – reference: 2. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15: 594-603. – reference: 6. Kubo K, Azuma A, Kanazawa M, Kameda H, Kusumoto M, Genma A, et al. Consensus statement for the diagnosis and treatment of drug-induced lung injuries. Respir Investig 2013; 51: 260-77. – reference: 9. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA 2002; 287: 236-40. – reference: 10. Marik PE, Varon J. Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature. Arch Surg 2008; 143: 1222-6. – reference: 3. Vuky J, Bains M, Bacik J, Higgins G, Bajorin DF, Mazumdar M, et al. Role of postchemotherapy adjunctive surgery in the management of patients with nonseminoma arising from the mediastinum. J Clin Oncol 2001; 19: 682-8. – reference: 7. Kesler KA, Rieger KM, Hammoud ZT, Kruter LE, Perkins SM, Turrentine MW, et al. A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors. Ann Thorac Surg 2008; 85: 371-8. – reference: 1. Comis RL. Bleomycin pulmonary toxicity: current status and future directions. Semin Oncol 1992; 19: 64-70. – reference: 11. Goldiner PL, Carlon GC, Cvitkovic E, Schweizer O, Howland WS. Factors influencing postoperative morbidity and mortality in patients treated with bleomycin. Br Med J 1978; 1: 1664-7. – reference: 4. Schneider BP, Kesler KA, Brooks JA, Yiannoutsos C, Einhorn LH. Outcome of patients with residual germ cell or non-germ cell malignancy after resection of primary mediastinal nonseminomatous germ cell cancer. J Clin Oncol 2004; 22: 1195-200. – reference: 5. Nichols CR, Catalano PJ, Crawford ED, Vogelzang NJ, Einhorn LH, Loehrer PJ. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol 1998; 16: 1287-93. – reference: 12. Donat SM. Peri-operative care in patients treated for testicular cancer. Semin Surg Oncol 1999; 17: 282-8. |
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| Snippet | ブレオマイシンによる間質性肺炎は総投与量依存性に頻度が増加する．高容量投与が必要となる縦隔胚細胞性腫瘍において，治療中に間質性肺炎を生じた場合は，その後の手... |
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| SubjectTerms | ブレオマイシン 縦隔悪性胚細胞性腫瘍 薬剤性肺炎 間質性肺炎 |
| Title | 縦隔原発悪性胚細胞性腫瘍に対するBEP療法中に発症した間質性肺炎治療後に手術を施行した2例 |
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