スキルス胃癌の化学療法

Chemotherapy for Scirrhous-type Gastric Cancer

要旨●近年の胃癌診療における薬物療法の進歩は著しく，分子標的薬をはじめとするさまざまな薬剤が薬事承認され，治療体系が大きく変化した．スキルス胃癌は予後不良な病型であり，病理学的に非充実型の低分化腺癌である症例が多いこと，腹膜播種を高頻度に伴うことが特徴である．腹膜播種による高度腹水や腸管狭窄を合併し，経口摂取困難となり，選択可能なレジメンが制限されることも珍しくない．スキルス胃癌に特化した治療開発は難しいが，サブグループ解析などを参考に既存の臨床試験を慎重に吟味することで有効性の予測は可能であり，各薬剤の性質も考慮し，他の肉眼型・組織型の胃癌と同様にすべての薬剤を使い切る治療戦略が重要である．

　Chemotherapy for gastric cancer has made remarkable progress due to recent governmental approval of various drugs, including monocularly targeted agents. SGC（scirrhous-type gastric cancer）is one of the special types of gastric cancer characterized by peritoneal dissemination and poorly differentiated pathological findings, which results to poor prognosis. Available regimens for SGC are often limited due to massive ascites or inadequate oral intake due to peritoneal metastasis. Although there are no new treatment developments specific for SCG, the subgroup analyses of cases with peritoneal dissemination or ascites from past clinical trials are useful to consider treatments. An approach that uses all available cancer drugs is the key for SGC treatments, similar to that of other types of gastric cancer.