肺癌の脈絡膜転移にガンマナイフ放射線治療と全身化学療法が有効であった1例

Gamma knife radiotherapy and chemotherapy were effective in a case of choroidal tumor metastatic from lung cancer

要約　目的：肺癌の脈絡膜転移にガンマナイフ放射線治療と全身の化学療法が奏効した症例の報告。症例：66歳女性が右眼の飛蚊症で受診した。矯正視力は右1.2，左1.5で，右眼に乳頭から上方に7乳頭径大で厚さ3.5mmの黄白色腫瘤があった。血液の腫瘍マーカーは肺または消化器系癌の可能性を示した。X線検査，内視鏡，ガリウムシンチは陰性であった。PETで肺に集積があり，造影CTで直径3cmの肺癌が初診7週間後に発見された。眼腫瘍は増大し，視力は0.4に低下していた。眼に対するガンマナイフ治療と化学療法を行い，7か月後に腫瘍は平坦化し，視力は0.9に改善した。初診から18か月後の現在まで経過は良好である。結論：比較的小さい肺癌からの脈絡膜転移にガンマナイフ治療と化学療法が奏効した。

Abstract.　Purpose：To report the effect of gamma knife radiotherapy and chemotherapy in a case of choroidal tumor metastatic from a lung tumor. Case：A 66-year-old female presented with myodesopsia in her right eye. Findings：Corrected visual acuity was 1.2 right and 1.5 left. The right fundus showed a yellowish tumor superior to the optic disc. Its diameter was 7 disc diameters and the thickness was about 3.5 mm. Examinations by X-ray,endoscopy,gallium scintigraphy were inconclusive. Positron emission tomography（PET）and enhanced CT led to the detection of a lung tumor of 30 mm in diameter 7 weeks after her initial visit. Choroidal tumor had increased in size with visual acuity down to 0.4. After gamma knife radiation and chemotherapy for 7 months,the choroidal tumor became flat with visual acuity of 0.9. She has been doing well for 18 months since her initial visit. Conclusion：This case illustrates that gamma knife radiation with chemotherapy may be effective for choroidal tumor metastatic from a small lung cancer.