腹膜播種を伴った高度進行胃癌に対するTS-1による術前化学療法の有用性

TS -１ is an oral anticancer agent developed by utilizing biochemical modulation. We
used TS -１in neoadjuvant chemotherapy for a patient with highly advanced gastric cancer
that was accompanied by peritoneal dissemination. This enabled us to resect tumor.
This patient was a６０-year-old woman. Fluoroscopic upper gastrointestinal series revealed
a circumferential, type４lesion extending from the middle of the corpus to the antrum. This
was diagnosed by endoscopy as poorly differentiated adenocarcinoma. CT showed ascites,
thickening of the gastric wall, and direct infiltration into the head of the pancreas. In
endoscopy of the large bowel, a strawberry jelly-like elevation was detected at the ileum.
This was diagnosed as poorly differentiated adenocarcinoma, and considered a metastatic
lesion produced by dissemination. Chest CT showed a single metastasis in the upper lobe
of the right lung. We gave her３cycles of combined TS-１and low-dose CDDP for neoadjuvant
chemotherapy. On laparotomy, we found that there was no ascites, and miliary scars were
present at several sites near the ascending colon. The antrum of the stomach firmly adhered
to the head of the pancreas, and scarred. We judged that the tumor was resectable, and
performed distal gastrectomy（D２）plus ileocecal resection（D２）．
In histopathological examination, poorly differentiated adenocarcinoma was detected
only on a part of the muscular layer in the lesser curvature and posterior wall of the corpus,
and marked fibrosis was observed in the submucosal layer. The effect of chemotherapy was
histologically evaluated as grade２. The tumor was diagnosed as poorly differentiated
adenocarcinoma（por）, with muscularis propria（mp）, lymph invasion２（ly２），vein invasion
０（v０）and degree of lymph node metastasis２（+）［n２（+）］. Tubular adenocarcinoma was
detected in a part of the submucosal layer of the ileum. The patient was alive with cancer
as of２７months after operation.

四国医学雑誌 : http://www.tokushima-u.ac.jp/med/research/shikoku_acta_medica.html