脊髄Glioblastoma Multiformeの1症例

A Case of Spinal Cord Glioblastoma Multiforme

I．はじめに

　Gliobiastoma multiforme（以下GM）は予後不良な腫瘍であるが^7），脊髄GMは特に予後不良と思われ，3年生存例をほとんど認めない^{2-6,8,10,12,13,15）}．われわれは脊髄円錐部に原発した本症に対し亜全摘術（初回手術），放射線療法（65Gy），化学療法，lymphokine-activated kil—ler（以下LAK）細胞髄腔内注入療法，脊髄切断術（再発時手術）を施行し，3年6ヵ月をこえて生存している症例を経験したので，若干の文献的考察を加えて報告する．

A 35-year-old woman was admitted to our hospital with a 3 month history of progressive paraparesis and impairment of bowel and bladder function. MRI sug-gested a malignant glioma at the level of T9 to LI. Laminectomy and subtotal removal of the tumor was performed. The surgical specimen was a glioblastomamultiforme. An aggressive adjuvant therapy was sche-duled to prevent rapid local regrowth and leptomenin-geal dissemination. Radiotherapy with a total dose of 65Gy was delivered with chemotherapy including ACNU (2mg/kg) and vincristine (0.2mg/kg). Lympho-kine-activated killer (LAK) cells were given intrathe-cally with a total dose of 1.6×10⁹ LAK cells with 3×10⁴ units of IL-2. MRI taken 6 months after surgery re-vealed no residual tumor, and no malignant cell was de-tected in the patient's CSF. After physiotherapy, she became able to walk with a stick and was discharged. Chemotherapy (ACNU 2mg/kg/8 weeks) had been further continued for 2 years. She did well until 14 months after surgery, when paraparesis recurred and rapidly progressed to completism. MRI revealed a spin-al cord swelling with marked edema, suggesting de-layed radiation necrosis. Two years after surgery, MRI showed a marked atrophy of the spinal cord, and no re-sidual tumor. But 3 years after surgery, a round tumor at the level of T₁₁ and T₁₂, was revealed on MRI, and she was admitted to our hospital again. A spinal cord amputation was performed, and the tumor was totally removed without worsening her neurological symp-toms. Surgical specimen of the tumor was glioblastoma multiforme again. Thirty-nine months after the first surgery she has been living at home as a house wife. The prognosis of spinal cord glioblastoma is quite fear-ful. The rapid postoperative regrowth and the high fre-quency of leptomeningeal dissemination appear to be responsible. The authors pointed out that to suppress the former a local high-dose irradiation is recom-mended, and to prevent the latter an intrathecal infu-sion of LAK cells may be effective.