化学療法が奏効した胃癌の2例

Good Responses to Chemotherapy for Patients with Advanced Gastric Cancer, Report of Two Cases

要旨　患者1例目は69歳，男性．近医で進行胃癌を指摘され，当院の内視鏡で食道浸潤と審査腹腔鏡で細胞診陽性を認めた．根治切除を期待して術前化学療法（S-1　3コース）を施行後，原発巣の著明な縮小を認めたため根治切除として胃全摘が施行された．病理組織で化学療法の効果による腫瘍の消失の変化と考えられる広範囲な線維化を認め，pStage IIIAの根治切除が得られた．2例目は58歳，男性．近医で進行胃癌を指摘され，当院の内視鏡で噴門部から幽門前庭部に広がる原発巣とCTで膵浸潤を伴う高度のリンパ節転移を認めた．リンパ節転移縮小を期待して術前化学療法〔cisplatin（CDDP）＋irinotecan（CPT-11）3コース〕を施行後，原発巣と転移巣の著明な縮小を認めたため根治切除が施行された．病理組織で広範囲な線維化，壊死巣から腫瘍細胞の2/3以上は消失したと考えられた．

　First case ; a male at the age of 69, was found by endoscopy to have advanced gastric cancer. Endoscopy showed invasion to the esophagus. The patient also underwent staging laparoscopy and his cytology was positive. He received 3 cycles of chemotherapy as neo-adjuvant setting (S-1, an oral fluoropyrimidine) and, according to the response of the primary lesion, he underwent curative total gastorectomy. Pathological findings indicated a wide range of fibration caused by the vanishing of the tumor.

　Second case ; a male at the age of 58, was found to have advanced gastric cancer. Endoscpopic findings showed a widespread Type 5 lesion between the cardia and the antrum and CT showed severe lymph node swelling directly invading the head of the pancreas. He received 3 cycles of chemotherapy as neo-adjuvant setting (cisplatin with irinotecan, a combination treatment) and underwent gastorectomy after the good response for LN metastasis. Pathological findings indicated a wide range of fibration and necrosis caused by the vanishing of the tumor. The area of the vanishing tumor in response to the treatment extended to two thirds of the whole tumor.