術前化学療法により組織学的完全奏効が得られた高度浸潤直腸癌の1例
症例は69歳，男性．血便を主訴に近医を受診，直腸癌を疑われ当院紹介となった．下部消化管内視鏡検査では直腸Rasbに環周率90％の2型腫瘍を認め生検結果は高分化管状腺癌であった．CT・MRIで膀胱，精嚢への浸潤を認め，直腸傍・右側方リンパ節転移を疑った．他臓器浸潤直腸癌Rasb，2型，cSI，cN3，cH0，cP0，cM0，cStageIIIbと診断した．経過中に大腸イレウスを発症したため人工肛門を造設した．側方リンパ節転移と周囲臓器への高度な浸潤を認めていたため化学療法を先行した．mFOLFOX6を4コース施行し，その内bevacizumabを2回併用した．その後，原発巣は著明に縮小し部分奏効...
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| Published in | 日本臨床外科学会雑誌 Vol. 71; no. 10; pp. 2676 - 2681 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.71.2676 |
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| Abstract | 症例は69歳，男性．血便を主訴に近医を受診，直腸癌を疑われ当院紹介となった．下部消化管内視鏡検査では直腸Rasbに環周率90％の2型腫瘍を認め生検結果は高分化管状腺癌であった．CT・MRIで膀胱，精嚢への浸潤を認め，直腸傍・右側方リンパ節転移を疑った．他臓器浸潤直腸癌Rasb，2型，cSI，cN3，cH0，cP0，cM0，cStageIIIbと診断した．経過中に大腸イレウスを発症したため人工肛門を造設した．側方リンパ節転移と周囲臓器への高度な浸潤を認めていたため化学療法を先行した．mFOLFOX6を4コース施行し，その内bevacizumabを2回併用した．その後，原発巣は著明に縮小し部分奏効を得たため根治術を行った．手術では腫瘍は膀胱，精嚢，前立腺と一塊に存在し，腫瘍の残存を疑いこれらの臓器を含めた骨盤内臓全摘術を施行した．病理組織学的検査では，癌細胞は認めず組織学的完全奏効と判定した． |
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| AbstractList | 症例は69歳，男性．血便を主訴に近医を受診，直腸癌を疑われ当院紹介となった．下部消化管内視鏡検査では直腸Rasbに環周率90％の2型腫瘍を認め生検結果は高分化管状腺癌であった．CT・MRIで膀胱，精嚢への浸潤を認め，直腸傍・右側方リンパ節転移を疑った．他臓器浸潤直腸癌Rasb，2型，cSI，cN3，cH0，cP0，cM0，cStageIIIbと診断した．経過中に大腸イレウスを発症したため人工肛門を造設した．側方リンパ節転移と周囲臓器への高度な浸潤を認めていたため化学療法を先行した．mFOLFOX6を4コース施行し，その内bevacizumabを2回併用した．その後，原発巣は著明に縮小し部分奏効を得たため根治術を行った．手術では腫瘍は膀胱，精嚢，前立腺と一塊に存在し，腫瘍の残存を疑いこれらの臓器を含めた骨盤内臓全摘術を施行した．病理組織学的検査では，癌細胞は認めず組織学的完全奏効と判定した． |
| Author | 冨樫, 一智 安田, 是和 山口, 岳彦 熊野, 秀俊 田口, 昌延 宮倉, 安幸 堀江, 久永 |
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| References | 14) Hassan I, Larson DW, Cima RR, et al : Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 2006 ; 49 : 1266-1274 15) Guillem JG, Chessin DB, Cohen AM, et al : Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 2005 ; 241 : 829-838 1) 石橋敬一郎，傍島 潤，横山 勝他:切除不能・再発大腸癌に対するmFOLFOX6療法の使用経験．癌の臨 2007;53:57-63 17) Calvo FA, Serrano FJ, Diaz-Gonzalez JA, et al : Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation. Ann Oncol 2006 ; 17 : 1103-1110 6) Okosi K, Nagayama S, Furu M, et al : A case report of pathologically complete response of a huge rectal cancer after systemic chemotherapy with mFOLFOX6. Jpn Clin Oncol 2009 ; 39 : 528-533 3) Colucci G, Gebbia V, Paoletti G, et al : Phase III randomized trial of FOLFIRI versus FOLFOX 4 in the treatment of advanced colorectal cancer : A multicenter study of the gruppo oncologico Dell Italia meridionale. J Clin Oncol 2005 ; 23 : 4866-4875 11) Heriot AG, Tekkis PP, Fazio VW, et al : Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer : a predictive model. Ann Surg 2005 ; 242 : 502-511 7) Hasegawa H, Watanabe M, Baba H, et al : Neoadjuvant chemotherapy of irinotecan, 5-fluorouracil and leucovorin in patients with advanced rectal cancer. report of two cases. Hepatogastoroenterology 2002 ; 49 : 891-893 12) Birgisson H, Pahlman L, Gunnarsson U, et al : Adverse effects of preoperative radiation therapy for rectal cancer : long-term follow-up of the Swedish rectal cancer trial. J Clin Oncol 2005 ; 23 : 8697-8705 5) 小林健司，安部真梨子，上田修久他:modified FOLFIRIで病理学的CRを得た後に急激に骨髄転移からDICを来たした直腸低分化腺癌の1例．日本大腸肛門病会誌 2009;62:65-71 10) Pollack J, Holm T, Cedermark B, et al : Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 2006 ; 93 : 1519-1525 8) Marijnen CA, van de Velde CJ, Putter H, et al : Impact of short-term preoperative radiotherapy on health-related quality of life and sexal functioning in primary rectal cancer : report of a multicenter randomized trial. J Clin Oncol 2005 ; 23 : 1847-1858 2) Aparicio J, Fernandez-Martos C, Vicent JM, et al : FOLFOX alternated with FOLFIRI as first-line chemotherapy for metastatic colorectal cancer. Clin Colorectal Cancer 2005 ; 5 : 263-267 16) Rodel C, Martus P, Papadoupolos T, et al : Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005 ; 23 : 8688-8696 9) 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 13) Pollack J, Holm T, Cedermark B, et al : Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 2006 ; 49 : 345-352 18) Capirci C, Rubello D, Chierichetti F, et al : Restaging after neoadjuvant chemoradiationtherapy for rectal adenocarcinoma : role of F18-FDG PET. Biomed Pharmacother 2004 ; 58 : 451-457 4) Tournigand C, Andre T, Achille E, et al : FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer : A randomized GERCOR study. J Clin Oncol 2004 ; 22 : 229-237 |
| References_xml | – reference: 5) 小林健司，安部真梨子，上田修久他:modified FOLFIRIで病理学的CRを得た後に急激に骨髄転移からDICを来たした直腸低分化腺癌の1例．日本大腸肛門病会誌 2009;62:65-71 – reference: 12) Birgisson H, Pahlman L, Gunnarsson U, et al : Adverse effects of preoperative radiation therapy for rectal cancer : long-term follow-up of the Swedish rectal cancer trial. J Clin Oncol 2005 ; 23 : 8697-8705 – reference: 8) Marijnen CA, van de Velde CJ, Putter H, et al : Impact of short-term preoperative radiotherapy on health-related quality of life and sexal functioning in primary rectal cancer : report of a multicenter randomized trial. J Clin Oncol 2005 ; 23 : 1847-1858 – reference: 10) Pollack J, Holm T, Cedermark B, et al : Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 2006 ; 93 : 1519-1525 – reference: 3) Colucci G, Gebbia V, Paoletti G, et al : Phase III randomized trial of FOLFIRI versus FOLFOX 4 in the treatment of advanced colorectal cancer : A multicenter study of the gruppo oncologico Dell Italia meridionale. J Clin Oncol 2005 ; 23 : 4866-4875 – reference: 1) 石橋敬一郎，傍島 潤，横山 勝他:切除不能・再発大腸癌に対するmFOLFOX6療法の使用経験．癌の臨 2007;53:57-63 – reference: 9) 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: 17) Calvo FA, Serrano FJ, Diaz-Gonzalez JA, et al : Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation. Ann Oncol 2006 ; 17 : 1103-1110 – reference: 11) Heriot AG, Tekkis PP, Fazio VW, et al : Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer : a predictive model. Ann Surg 2005 ; 242 : 502-511 – reference: 13) Pollack J, Holm T, Cedermark B, et al : Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 2006 ; 49 : 345-352 – reference: 7) Hasegawa H, Watanabe M, Baba H, et al : Neoadjuvant chemotherapy of irinotecan, 5-fluorouracil and leucovorin in patients with advanced rectal cancer. report of two cases. Hepatogastoroenterology 2002 ; 49 : 891-893 – reference: 14) Hassan I, Larson DW, Cima RR, et al : Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 2006 ; 49 : 1266-1274 – reference: 15) Guillem JG, Chessin DB, Cohen AM, et al : Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 2005 ; 241 : 829-838 – reference: 16) Rodel C, Martus P, Papadoupolos T, et al : Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005 ; 23 : 8688-8696 – reference: 18) Capirci C, Rubello D, Chierichetti F, et al : Restaging after neoadjuvant chemoradiationtherapy for rectal adenocarcinoma : role of F18-FDG PET. Biomed Pharmacother 2004 ; 58 : 451-457 – reference: 2) Aparicio J, Fernandez-Martos C, Vicent JM, et al : FOLFOX alternated with FOLFIRI as first-line chemotherapy for metastatic colorectal cancer. Clin Colorectal Cancer 2005 ; 5 : 263-267 – reference: 4) Tournigand C, Andre T, Achille E, et al : FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer : A randomized GERCOR study. J Clin Oncol 2004 ; 22 : 229-237 – reference: 6) Okosi K, Nagayama S, Furu M, et al : A case report of pathologically complete response of a huge rectal cancer after systemic chemotherapy with mFOLFOX6. Jpn Clin Oncol 2009 ; 39 : 528-533 |
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| Title | 術前化学療法により組織学的完全奏効が得られた高度浸潤直腸癌の1例 |
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