集学的治療により長期生存を得た腹膜播種を伴う4型胃癌の1例

Type 4 Gastric Cancer with Peritoneal Dissemination, Successfuly Treated with Multimodal Therapy, Report of a Case

要旨　症例は40歳男性で，腹部膨満・胃痛を訴え，精査にて腹水を伴う4型胃癌〔T2（SS）以上 N1M0H0P1，cStage IV〕と診断された．初回治療としてS-1/low dose cisplatin（TSLD）＋放射線療法を施行し，さらに外来にて1cycle追加した．腹水消失，原発巣の改善，肝転移巣（S4）出現にてCPT-11/S-1外来投与に変更し，その後肝転移巣は消失した．治療開始11か月後，肝・腹膜転移巣の増悪なく，本人の希望にて根治切除（胃全摘，リンパ節郭清術）が行われた．術後合併症はなく早期に退院した．病理組織学的にpT3（SE）N0M0P0，pStage IIと診断された．現在治療開始1年5か月後，再発の徴候はない．

　A forty-year-old male, with abdominal distension and gastric pain as his main complaint, was diagnosed, by endoscopy and abdominal computed tomography, as type 4 gastric cancer with ascites. It was confirmed as T3N1M0H0P1, cStage IV gastric cancer. As curative treatment was impossible by surgery, S-1/low dose CDDP (TSLD) with radiation therapy was chosen as the initial treatment. After 2 cycles of TSLD with 40 Gy radiation therapy, disappearance of ascites and improved appearance of the stomach were confirmed. However, solitary liver metastasis was detected at this time. Chemotherapeutic regimen was changed to the CPT-11/S-1 regimen against the liver tumor, on an outpatient basis. This resulted in complete response of the liver metastasis at 8 months after the initial treatment. In accord with the patient's wish, curative surgery (total gastrectomy and appropriate lymph node dissection) was performed 11 months after the initial treatment. The patient recovered without any postoperative complication. Histological investigation diagnosed pT3 (SE) N0M0P0, pStage II gastric cancer. He is alive without recurrence of the disease at 1 year and 5 months after initial treatment.