肝転移を有する精巣腫瘍に対し抗癌剤肝動脈注入が奏効した2症例

Abstract

精巣腫瘍の予後不良因子として, 1)直径2cm以上の肺転移, 2)腹部腫瘤を触知する症例, 3)肝転移例, 4)下大静脈への浸潤例が挙げられている.自験例は2例とも1～3までを満たし予後不良と考えられた.初回導入療法としてPVeBV療法を施行した.しかし2例とも肺転移巣, リンパ節転移巣の縮小は得られたものの肝転移巣の増大が認められた.症例2に肝動注を行った際, カテーテル先端を総肝動脈までしか入れなかったため, 十二指腸球部に潰瘍を形成し, 多量の輸血を必要とするような吐血を引き起こしてしまった.その為, 2回目以後は, 胃十二指腸動脈をcoilingし固有肝動脈内までカテーテルを挿入するようにした.2例ともinduction療法でも肝転移巣が増大傾向を示した為, 肝動注を行い転移巣が縮小した.1例はCRを, もう1例も今後CRとなる可能性もあると思われた

Two cases of testicular tumors with lymph node involvement and multiple lung and liver metastases were treated successfully with intra-arterial infusion chemotherapy. Case 1: A 30-year-old man presented with right scrotal swelling and an abdominal mass. He had a large retroperitoneal mass and multiple lung and liver metastases on computed tomographic (CT) scan and chest X-ray. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed embryonal cell carcinoma and choriocarcinoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was started and repeated for 2 courses. The retroperitoneal mass and lung tumors decreased in size, but liver tumors enlarged. Systemic and intrahepatic arterial infusion combined with chemotherapy was administered, and intra-arterial chemotherapy (cisplatin, VP-16) was added. The patient also received systemic chemotherapy (carboplatin, VP-16, ifosfamide). After chemotherapy, retroperitoneal lymph node dissection was performed. Microscopic examination revealed no viable cancer cells. On CT scan, no retroperitoneal, liver, or lung tumor was detected. Case 2: A 43-year-old man presented with right scrotal swelling and an abdominal mass. CT scan revealed a large retroperitoneal mass as well as lung and multiple liver metastases. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed seminoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was administered, but the liver tumors ware enlarged on CT scan. Intrahepatic arterial infusion chemotherapy (cisplatin, VP-16) was started and repeated for 4 courses. On CT scan, the lung metastasis seemed to have disappeared, and the retroperitoneal mass and liver metastases were decreased in size.