齋藤 心

症例1:52歳女,症例2:58歳男.共に胃全摘除術後空腸嚢(pouch)再建例であった.術後より食後の胸つかえ感や嘔吐により再入院が必要となり,レントゲン及び内視鏡でpouch内に多量な残渣を認めた.これに対してツムラ大建中湯エキス剤15g/日分3のを投与したところ,嘔吐,腹痛発作は全く消失し,通過障害の著明な改善を認めて体重も増加し外来通院中である

58歳女.多発性肝転移を伴うS状結腸癌に対してS状結腸切除術を施行した.術後に肝動注用リザーバーから,5-fluorouracil(5-FU)による持続動注を施行した.2回目の5-FU動注施行中に胸背部痛が出現し,心電図検査で広範なST上昇を認め,狭心症と診断された.3回目の動注施行時に再び狭心症発作が出現した為,5-FUによる狭心症と診断して5-FUを中止した.肝転移の進行により原病死した

Cardiac toxicity of 5-fluorouracil (5-FU) has been rarely reported. We encountered a case of angina attack caused by 5-FU. A 58-year-old Japanese woman underwent sigmoidectomy for a sigmoid colon carcinoma with multiple liver metastases. Two months after surgery, she received chemotherapy comprising hepatic arterial infusion of 5-FU. During the 2nd chemotherapy session 7 days after the first, she complained of anterior chest pain. Her electrocardiograms showed elevations of the ST segment in almost all leads, confirming the diagnosis of angina pectoris. Soon after the third chemotherapy session the same type of attack occurred again. The close association of the attacks with 5-FU administration suggested that the angina might have been induced by 5-FU. Further attacks were avoided by discontinuing the 5-FU thereafter. The incidence of cardiac toxicity 5-FU has been reported to be 1.6-7.6%. Labianca et al. found 17 cases of 5-FU-associated cardiopathy, 15 of which were angina pectoris, out of 1,083 patients treated with the drug for various kinds of neoplasm. Analysis of 6 domestic cases including ours revealed that all patient lacked a previous history of cardiac disease except one who had an arrhythmia. There seemed to be no dose-dependent correlation with 5-FU-induced angina. Cardiac events were found even in the earlier phase of chemotherapy. Since 5-FU is widely used in the treatment of a number of gastrointestinal malignancies, one should bear in mind its cardiac toxicity, manifested as angina pectoris.

閉塞性黄疸を起こした再発・切除不能胃癌の3例に対し,TS-1の隔日投与を試みた.3症例とも肝機能を含めて全身状態は良好ではなかったが,治療継続が可能であった.2例で化学療法の効果を確認でき,1例は14ヵ月間のlong NCの状態で通院中,1例は腫瘍マーカーの減少を認めた.TS-1は短剤でも高い奏効率(44〜49%)が得られ,かつ通院での治療を維持できる.しかし,骨髄抑制や皮膚障害,消化器障害などを認めることがあり,減量や休薬を余儀なくされることがある.TS-1の隔日投与は,抗腫瘍効果を維持しつつ有害事象の発現を軽減させる長期投与法として展望があると思われた

We report 3 cases in which palliation was achieved with every-other-day administration of TS-1 for recurrent or non-curative advanced gastric carcinoma that had resulted in obstructive jaundice. Two patients had received MTX-5-FU chemotherapy as first-line therapy and showed progressive disease, presenting with obstructive jaundice 6-24 months later. One of them experienced obstructive jaundice 2 months after surgery. After lowering serum bilirubin via per-cutaneous transhepatic biliary drainage (PTBD), TS-1 was given not in full dose but every other day based upon Shirasaka's theory, as well as for fear of further liver damage. Palliation in terms of long NC and/or decreased serum CEA level persisted for 4-14 months without severe liver dysfunction. Other side effects of the drug were negligible. Shirasaka's theory stresses the difference in proliferation cycles between cancer cells and normal tissue cells (GI tract, bone marrow, etc.); therefore, with every-other-day administration of chemotherapeutic agents, the cytotoxic effects against tumors would be augmented while the adverse reactions in normal cells could be reduced. The present experience seems to support the theoretical and clinical feasibility of every-other-day TS-1 administration for unresectable gastric cancer.