血液透析下にカルボプラチンとエトポシドによる併用化学療法を行った小細胞肺癌の1例

A Case of Small-cell Lung Carcinoma Treated with Carboplatin plus Etoposide Combination Chemotherapy under Hemodialysis

要旨　近年，慢性腎不全による維持透析患者の増加により，透析施行患者において肺癌が発見される症例が増加しているが，肺癌合併透析症例における化学療法の明確な標準治療は確立されていない．今回限局型小細胞肺癌を合併した慢性腎不全患者に対し，維持血液透析を導入し，カルボプラチン300mg/m²(day1)およびエトポシド50mg/m²(day1，day3)での治療を行った．本邦で2000年以降報告された血液透析下にカルボプラチン＋エトポシドを使用した小細胞肺癌の報告例16例を検討したところ，安全性に配慮しながら当初に高用量を使用し，必要に応じ減量することで，良い効果が得られる可能性が示唆された．本例でも同様の方法で安全に治療を遂行することができたが，治療効果はSD(stable disease)であった．至適投与量に関してはさらなる検討が必要と考える．

　In recent years there are many patients who undergo hemodialysis because of chronic renal failure. Along with that, cases where lung cancer is discovered in patients undergoing hemodialysis are increasing. However, a standard chemotherapy for lung cancer patients undergoing maintenance hemodialysis has not yet been established with this in mind,we conducted chemotherapy using carboplatin 300mg/m² (day 1) plus etoposide 50mg/m² (day 1,3) in a patient with limited-stage small cell lung cancer, who was also receiving maintenance hemodialysis. We investigated 16 small-cell lung cancer cases reported since 2000 in Japan that had been treated with carboplatin and etoposide under hemodialysis for chronic renal failure. Reviewing these cases, it is suggested that most effective schedule would be to use a higher dose in the first course followed by dose reduction as necessary for further courses. Although we were able to treat this case safely, the response was limited to an SD (stable disease). Further study is needed to determine the optimal dosage of each drug for small-cell lung cancer with maintenance hemodialysis.