新規フツ化ビリミジン系経口抗癌剤（TS－1）とCDDP選択的動注の併用療法が奏効した舌癌の1例

摘要

64歳，男性の舌扁平上皮癌一次症例（T3N0MO）に対して新規フツ化ビリミジン系経口抗癌剤TS-1投与とCDDPの選択的動注療法を行った。 既往歴として肺気腫を合併し，肺機能が低下しており全身麻酔下での手術施行は困難であった。 そこでTS－1を先行投与し（100mg/day），TS－1投与1週間後よりCDDP選択的動注（CDDP5mg/day）を併用した。TS-l投与8日目（動注開始2日目）には腫瘍は著しく縮小し，TS－1投与15日目（動注開始9日目）には腫瘍はほぼ消失した。 TS－1投与開始20日目（動注開始14日目），副作用でぁる悪心·嘔吐を認めたため抗癌剤の投与を中止した。 以後，点滴静注による栄養管理および制吐剤の投与を行い，投与中止1週後に副作用は改善された。 治療開始後5週目で腫瘍は肉眼的には消失しCRであった。 さらに追加療法として組織内照射を行い，治療開始1年4か月後の2002年9月3日現在外来にて経過観察を行っているが再発を認めず経過良好である。 本治療法は若干の副作用を認めるもののその程度は比較的軽く，また効果も十分に認められることから，既往歴が存在し全身状態の思わしくない症例に対して有効な治療法であることが考えられた。 A 64-year-old male with primary squamous cell carcinoma of the tongue (T3NOMO) was treated with the novel fluoropyrimidine oral anticancer drug TS-1 and selective intra-arterial infusion of CDDP, His past history revealed pulmonary emphysema as a complication. Since his pulmonary function was reduced and it would have been difficult to perform surgery under general anesthesia, we started administration of TS-1 (100 mg/ day) first and added selective arterial infusion of CDDP (5 mg/day) after one week of TS-1, On day 8 of TS-1 administration (day 2 of arterial infusion), the tumor had shrunk considerably, and on day 15 of TS-1 administration (day 9 of arterial infusion) the tumor had almost completely disappeared,. Nausea and vomiting developed as adverse effects on day 20 of TS-1 administration (day 14 of arterial infusion), and administration of the anticancer drugs was stopped, Nutrition management and an antiemetic agent were started by intravenous drip infusion, and the adverse effects improved one week after administration was stopped. By the 5th week after the start of treatment, the tumor had disappeared macroscopically, and a CR had been achieved,. Interstitial radiotherapy was performed as supplemental therapy, and as of this writing, September 3, 2002,16 months after the start of treatment, 'the patient is being followed on an outpatient basis. His course has been favorable and recurrence-free.