全身大量メソトレキセート療法とカルボプラチン動注療法が奏効した小児頭蓋骨骨肉腫の1例

Successful Treatment with Administration of Systemic High Dose Methotrexate and Intraarterial Carboplatin for Osteosarcoma of the Skull:A case report

Ⅰ．はじめに

　骨肉腫の多くは若年者の長管骨の骨幹端に発生し，およそ7-10万人に1例の割合で発症するといわれている^16）このうち頭蓋骨に原発する骨肉腫は，骨肉腫症例全体の0.1-2％と見積もられている^12）．長管骨の骨肉腫に対しては現在までに多くの治療プロトコールによる治療成績が報告されているが^{1-4,10,11,15）}，頭蓋骨原発の骨肉腫に対する治療についての報告は少ない^9,12）．今回われわれは手術に加え，補助化学療法としてロイコボリン救援併用大量メソトレキセート全身投与と，カルボプラチン，メソトレキセート動注療法にて寛解を得られた症例を経験したので報告する．

An 11-year-old boy was admitted with a painless lump in the right frontal area as his chief complaint. On admission, physical and neurological examinations were normal except for the localized lump constituting the frontal lesion. Skull roentgenogram showed an osteob-lastic and osteolytic mass with radiating bony spicules “sunray appearance” around the coronal suture. CT scans demonstrated it more clearly. The initial surgery was performed in July 1993. Pathological specimen showed osteosarcoma of the skull. The patient was transferred to our hospital for chemotherapy. The reg-imen consisted of intravenous high dose methotrexate 9,000 mg given for 6 hours with leucovorin rescue in a single course.

Following 4 courses of high dose methotrexate, he underwent residual tumor resection. Two courses of intraarterial carboplatin 150 mg and methotrexate 200 mg were also given. Histologically, the lesion showed complete remission of the tumor, andno viable tumor cells were seen. Two additional courses of high dose methotrexate were given. The patient is doing well without evidence of recurrence. This case in-dicates that the chemotherapy with systemic high dose methotrexate and intraarterial carboplatin and metho-trexate is effective for skull osteosarcoma.