集学的治療により脳転移・肺転移が消失した腎癌の1例

Abstract

51歳男性.患者は右胸部痛を主訴に近医を受診, 胸部X線・CTにて右胸水, 多発性肺腫瘍を指摘され, 著者らの施設へ紹介入院となった.胸部CTでは上記所見とともに左腎腫瘍が発見され, 精査の結果, 左腎癌の肺転移と診断し, 根治的左腎摘除術を施行した.病理組織学的にClear cell carcinomaで, 術後, 肺転移に対しIFN-α投与を開始したが, 1ヵ月後より四肢の痺れが出現した.頭部CT・MRIにて脳転移と診断し, gamma knife radiosurgeryを行ったところ, 脳転移は消失した.肺転移はIFN-αとIL-2の併用投与にて消失が得られたが, 治療中うつによる自殺企図をおこした.INF-αまたはIL-2による副作用と診断し, 両薬剤を中止し, 抗うつ剤投与にて精神状態の安定が得られた

A 51-year-old man with left renal tumor and multiple lung metastases was admitted to our hospital for treatment. Left nephrectomy was performed, and pathological diagnosis was renal cell carcinoma (clear cell carcinoma, G2, pT3a). Initially, Interferon-alpha (IFN-alpha) therapy was started for lung metastases. About 40 days after surgery, head magnetic resonance imaging revealed brain metastases, and therefore gamma knife radiosurgery(GKS) was performed. Since chest computed tomography showed no change in lung metastases, we tried a combination of interleukin-2 (IL-2) and IFN-alpha therapy to elininate those metastases. As a result, neither lung nor brain metastases could be detected at the 4th month follow-up examination. At 5 months after the IL-2 and IFN-alpha therapy, the patient attempted suicide. Therefore, the IL-2 and IFN-alpha therapy was stopped and an antidepressant was prescribed. Now 11 months after withdrawal of the IL-2 and IFN-alpha, the patient's mental condition remains stable. No recurrence of the cancer has been detected by CT.