TIP(パクリタキセル, イフォマイド, シスプラチン)療法が奏功した脳転移を有する再発性精巣腫瘍の1例

Abstract

30歳, 男。右陰嚢内容腫脹で受診し, 右精巣は小手拳大で, alpha-fetoprotein(AFP)値, LDH値の上昇を認めた。右精巣腫瘍の診断で右高位精巣摘除術を施行した。病理学的にセミノーマ, 胎児性癌, 成熟奇形腫を認めた。AFP, LDHは低下し, stage Iと診断した。その後, 頭痛, 眩暈が出現し, MRIで右後頭部に腫瘍を認めた。AFPは上昇し, CTでは左肺野, 脾臓に腫瘍を認めた。再発性精巣腫瘍, 脳, 肺, 脾転移と診断し, シスプラチン, エトポシド, ブレオマイシンによるPEB療法を開始した。AFPは正常化しなかったため, エトポシド, イフォスファミド, シスプラチンによるVIP療法を施行したが, AFPは上昇した。肺, 脾, 脳転移の腫瘍が縮小したため, パクリタキセル, イフォスファミド, シスプラチンによるTIP療法を施行した。AFPは正常化し, 脾, 脳転移の消失, 肺転移の94%縮小を認めた。その後の腹腔鏡下肺腫瘍切除では残存腫瘍は認めず, 再発後約3年の現在, 再発は認めていない。

A 30-year-old man was diagnosed with testicular cancer, and underwent a radical orchiectomy. Pathological diagnosis was a mixed type nonseminomatous germ cell tumor. We diagnosed him as having stage I testicular cancer and decided to forgo adjuvant therapy. After 8 months of follow-up, he was admitted to our department because of brain, lung, and spleen metastases. Since the serum alpha-fetoprotein (AFP) level was present at a high level at 1, 297 ng/ml, he was given combination chemotherapy consisting of 3 cycles of PEB, cisplatin, etoposide and bleomycin and one cycle of PE, cisplatin and etoposide. Because of the decline in lung diffusing capacity, the administration of bleomycin was stopped in the final course. However, the AFP level remained above 14 ng/ml. Then he was given one more cycle of VIP therapy (etoposide, ifosfamide, cisplatin), but the serum AFP level was increased to 56 ng/ml. Then, two cycles of chemotherapy with paclitaxel, ifosfamide and cisplatin were administered as salvage chemotherapy, which led to a normalization of the serum AFP level, and disappearance of the brain and spleen metastases. Residual lung mass was resected at the surgical department, and microscopically no viable tumor cells remained. Three years after his final hospitalization, the patient has had no evidence of recurrence or metastasis.