FOLFOX4(オキサリプラチン, ロイコボリン, 5-FU)を術前抗癌化学療法に用いた尿膜管癌の1例

Abstract

52歳女。患者は肉眼的血尿, 下腹部痛を主訴とした。諸検査により術前臨床診断は尿膜管癌, 遠隔転移はないが小腸への直接浸潤が疑われる状態と判断した。組織型決定のためには経尿道的切除術が必要と考えられ, 腺癌を前提に, 再発大腸癌に対する3剤併用化学療法のfirst lineであるFOLFOX4(オキサリプラスチン, ロイコボリン, 5-FU)を導入し, 術前に減量せず3クール施行した。術前効果判定で35%の腫瘍縮小率を認めて膀胱温存可能と判断し, 尿膜管全摘除術と膀胱部分切除術が施行された。その結果, 病理診断では周囲の壊死細胞の中に角化を示す大小不同の異型細胞が認められ, 高分化の扁平上皮癌の所見であった。術後はFOLFOX4を1クール施行し, 1年半経過現在, 再発転移は認められていない。

A 52-year-old woman was referred to our hospital for treatment of urachal cancer. She complained of supurapubic dull pain and gross hematuria. Computed tomography and magnetic resonance imaging showed a non-papillary sessile tumor, which was located on the dome of the bladder and invaded the small intestine. The tumor was diagnosed as Sheldon's stage IIIC urachal cancer. After three courses of neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin), the tumor was reduced from 7 x 6 cm to 5.5 x 5 cm in size. Consequently, the patient underwent an en-bloc resection of the urachal tumor with the dome of the bladder and the parts of the ileum invaded by the tumor. One course of adjuvant chemotherapy (FOLFOX4) was performed. Surgical specimen revealed histologically well differentiated squamous carcinoma and invasion to the propria of the ileum. The surgical margins were negative for the cancer. For 1.5 years after the surgery, no local recurrence or distant metastasis has been observed.