腎癌の多発転移に対して機能温存的治療で長期の生命予後を保ちえた2例

Abstract

症例1:58歳男.人間ドックで左腎腫瘍を指摘され, 経腹的根治的左腎摘除術を施行した.術後12年目に左肺底部結節影の増大傾向を認めたため, 胸腔鏡下左肺下葉部分切除術を施行した.病理結果はClear cell carcinomaで, 左腎癌の転移と診断された.約5ヵ月後, 頭頂葉転移を認め, 腫瘍からの出血による脳ヘルニアを来たし, 開頭血腫除去及び腫瘍摘出術を施行した.更にその後, 左前頭葉と左後頭葉に新たな転移巣を認めγナイフを施行した.現在著変なく生存中である.症例2:53歳男.右腎腫瘍であり, 経腹的根治的右腎摘除術を施行した.病理結果はRenal cell carcinomaであった.術後9年目に第4～7胸椎骨転移を認め放射線照射を施行し, その後の約3年間に左第5肋骨, 傍大動脈リンパ節, 仙骨, 胸骨の転移巣に対し放射線照射を行い, 更に左乳房下の皮膚及び左側胸部皮膚の転移巣に対し外科的切除を行った.照射により骨転移の痛みはいずれも改善し, リンパ節転移については縮小効果認めた

Case 1. A 58-year-old man underwent radical nephrectomy due to a tumor in the left kidney (renal cell carcinoma, clear cell subtype, G3, pT1bpN0) in 1988. Thirteen years later, he underwent surgical resection of metastases to lung and cerebrum and gamma ray knife resection of two other sites of metastases to cerebrum in 2001. He had no evidence of disease in April, 2003. Case 2. A 53-year-old man underwent radical nephrectomy due to a tumor in the right kidney (renal cell carcinoma, clear cell type, pT1apN0) in 1987. From 1996 to 2001, irradiation therapy to multiple metastases to thoracic vertebrae (50 Gy), rib (50 Gy), para-aorta lymph nodes (40 Gy), sacrum (44 Gy) and sternum (44 Gy), and surgical resection of dermal metastasis were performed. Paraplegia occurred due to regrowth of thoracic bone metastasis in December, 2001. In February, 2002, he died of septic shock caused by infection of decubitus. Surgical resection and palliative therapy of recurrent metastatic foci was useful to improve the quality of life and probably prognosis.