Paclitaxel/TS－1併用療法が著効した肺の癌性リンパ管症を伴う進行胃癌の1例

摘要

症例は65歳，男性。 肺の癌性リンパ管症を伴う進行胃癌で呼吸不全にて近医より紹介された。 5－fluorouracil（5-FU）＋cisplatin（CDDP）併用療法が著効し肺の癌性リンパ管症，原発巣ともに著明に改善したが，4クール後より再燃し，画像的にも肺病変，原発病変ともに増悪，息切れや胸部圧迫感が出現しFP療法不応と考えられたため，paclitaxel（TXL）単剤で1コース，さらにTXL＋TS－1併用療法に変更したところ，肺の癌性リンパ管症の著明な改善を得た。5－FU＋CDDP併用療法の不応例にTXL＋TS-l併用療法で改善を得た胃癌の癌性リンパ管症症例であり報告する。A 65-year-old man, who had been admitted to another hospital with complaints of severe cough and dyspnea, was transferred to our hospital for the further examination and therapy. The patient was diagnosed with advanced gastric cancer (type-3) with lymphangitis carcinomatosa of the lung, He was treated with combination therapy of 5-FU and cisplatin, and showed a complete response, However, because resistance was seen in the lymphangitis of the lung and the gastric lesion, and a liver metastasis was also seen, we attempted combination therapy with paclitaxel and TS-1 Sixty mg/m2/day of paclitaxel was administered intravenously on day 1 and 8, and TS-1 of 60-80 mg/m2/day was administered orally for 2 weeks followed by one drug-free week After 2 courses of the combination therapy, the patient achieved a remarkable response in the lymphangitis carcinomatosa of the lung, but a slight response in the liver metastasis and gastric lesion