堀江 久永

The aim of the present study was to present a retrospective review of 42 metastatic colorectal cancer (mCRC) patients treated using the XELIRI regimen as second-line chemotherapy during the period between 2010 and 2012. Patients were treated with capecitabine, 1,600 (≥65 years) or 2,000 mg/m2 (<65 years), on days 1-15, 200 mg/m2 irinotecan (CPT-11) on day 1, with or without 7.5 mg/kg bevacizumab on day 1 and every 21 days. A total of 21 patients underwent XELIRI and 21 underwent XELIRI plus bevacizumab treatment. Fifteen patients received continuous administration of bevacizumab in the first- and second-line settings [bevacizumab beyond progression (BBP)+], whereas 27 patients did not receive the treatment (BBP-). Forty patients (95.2%), including all the patients in the BBP+ group, received sequentially administered XELOX and XELIRI regimens from the first- to the second-line setting. The disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and adverse events were compared between the BBP- and BBP+ groups. The median relative dose intensity was similar (93.9% for capecitabine and 96.3% for CPT-11 in the BBP- group vs. 94.8% for capecitabine and 91.5% for CPT-11 in the BBP+ group). The DCR was 25.9% in the BBP- and 66.6% in the BBP+ groups (P=0.020). The median PFS was 3.5 months in the BBP- and 7.2 months in the BBP+ groups (P=0.028). The BBP+ group exhibited a higher median OS time compared to the BBP- group (12.5 months in the BBP- group vs. not reached in the BBP+ group; P=0.0267). The most common grade 3/4 adverse event (n≥20) was hypertension observed in the BBP+ group [three patients (20%)]: these three patients were well-controlled with a single antihypertensive drug. Treatment with sequentially administered XELOX and XELIRI regimens did not aggravate adverse events in the 40 patients. The results showed that the XELIRI regimen, involving continuous treatment with bevacizumab, was well-tolerated and effective as a second-line chemotherapy and sequentially administering XELOX and XELIRI was feasible and manageable for patients with mCRC.

S状結腸軸捻転症に対して，内視鏡的整復後に経肛門イレウス管を留置し，待機的に安全に腹腔鏡下手術を施行し得た2症例を経験したので若干の文献的考察を加えて報告する．症例1：83歳，男性．腹痛を主訴に受診．S状結腸軸捻転症と診断し，内視鏡的整復を行った．整復2日後に再発したため，内視鏡的整復を行い，経肛門イレウス管を留置し，6日後に腹腔鏡補助下S状結腸切除術を施行した．術後経過に問題なく退院した．症例2：89歳，女性．S状結腸軸捻転症の診断で内視鏡的整復を行ったが，整復3日後に再発したため内視鏡的整復後経肛門イレウス管を留置した．4日後に腹腔鏡補助下S状結腸切除術を施行し，術後経過に問題なく退院した．大腸軸捻転症の手術待機期間中に経肛門イレウス管を留置することは，腸管減圧による浮腫軽減と共に捻転再発が防止でき，十分な術前評価の後に安全に腹腔鏡下手術を行う上で有用と考えられた．

症例は64歳の男性。直腸癌、腹膜播種、肺転移に対して低位前方切除術を施行後mFOLFOX6+bevacizumab(BV)療法を導入した。28コース目のBV投与26日目に腹痛、発熱が出現、CT検査で骨盤内膿瘍とfree air、虫垂内の石灰化を認め緊急手術を施行した。虫垂穿孔による膿瘍形成を認め虫垂切除・膿瘍ドレナージ術を施行した。術後2日目に骨盤内留置ドレーンより腸液の流出を認め、再手術を行ったところ回腸穿孔を認めた。穿孔部は境界明瞭な円形であり、播種など腫瘍性変化は認めず、単純閉鎖術を行った。再手術後は経過良好で、初回術後19日で退院した。虫垂の病理学的所見は直腸癌播種の腫瘍崩壊による穿孔を示唆していた。消化管穿孔はBVの重篤な副作用の一つである。本症例では短期間に二度、異なる部位に消化管穿孔を認め貴重な症例と考え報告する。(著者抄録)