Gemcitabine,nedaplatin併用療法が有用であった尿管扁平上皮癌の1例

Abstract

46歳男.下腹部痛, 便秘が出現した.超音波検査, CTで径9cmの骨盤内腫瘤と左水腎症を指摘され, 後腹膜腫瘍の診断で入院した.開腹腫瘍摘除を試みるも, 腫瘍はS状結腸, 総腸骨動静脈, 仙骨に強固に癒着しており剥離不可能であった.病理組織結果は, 腹水はclass II, 腫瘍組織は低分化型扁平上皮癌であった.病期分類stage IVの原発性左尿管扁平上皮癌と診断した.進行性尿路移行上皮癌に準じたMEC療法を選択したが効果はSDと不良であった.組織培養法抗癌剤感受性試験の結果をもとに, gemcitabine, nedaplatinを用いた併用化学療法(GN)を施行し, PRであった.しかし, GN 2コース後と3コース後では, 腫瘍の大きさはほとんど変化なくSDであった.放射線外照射とテガフール・ウラシルを開始した.他臓器転移はなく退院し, 6ヵ月経過したが画像上残存腫瘍の増大を認めず, 腫瘍マーカーの上昇も認めていない

A 46-year-old man complained of lower abdominal pain, and his abdominal and pelvic computed tomographic scan revealed left hydronephrosis and a huge tumor (9 X 9 cm) in the left distal ureter involving the left iliac vessel that was considered unresectable. Histological diagnosis showed squamous cell carcinoma, and histoculture drug response assay (HDRA) suggested the effectiveness of gemcitabine and nedaplatin. A cycle of adjuvant chemotherapy consisting of MEC (methotrexate 30 mg/ m2: day 1 and 15, epirubicin 50 mg/m2: day 1, and cisplatin 50 mg/m2: day 2 and 3) was performed as a first line chemotherapy, but the size of the ureteral tumor did not change. He was treated with 3 cycles of systematic combination chemotherapy consisting of gemcitabine (1, 000 mg/m2: day 1 and 8) and nedaplatin (80 mg/m2: day 1). After 2 courses of chemotherapy, the tumor size was reduced by 50% (PR; RECIST guidelines) and the tumor markers (SCC, CYFRA, NSE, CEA, and CA19-9) dropped to within the normal range. There were no serious adverse events except for grade 3 neutropenia which spontaneously recovered. However, because the tumor size was not reduced after the third cycle of chemotherapy, we applied external beam radiation to the primary lesion and the metastatic retroperitoneal lymph node site. No evidence of residual tumor progression has been found for 6 months after radiation therapy. We concluded that GN chemotherapy may be useful for patients with squamous cell carcinoma of the ureter.