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論文
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滝沢, 昌也 ; 小田, 誠 ; 太田, 安彦 ; 川上, 和之 ; 常塚, 宣男 ; 松本, 勲 ; 田村, 昌也 ; 谷内, 毅 ; 渡辺, 剛 ; 高仲, 強 ; 西嶋, 博司 ; 松井, 修 ; Takizawa, Masaya ; Oda, Makoto ; Ohta, Yasuhiko ; Kawakami, Kazuyuki ; Tsunezuka, Yoshio ; Matsumoto, Isao ; Tamura, Masaya ; Yachi, Tsuyoshi ; Watanabe, Go ; Takanaka, Tsuyoshi ; Nishijima, Hiroshi ; Matsui, Osamu
概要:
金沢大学医薬保健研究域医学系<br />We evaluated the efficacy of perioperative targeting brachytherapy for lung cancer invading the ches
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t wall. Between 1998 and 2003, 7 patients underwent perioperative targeting brachytherapy for lung cancer invading the chest wall. There were 5 male and 2 female patients. The mean age was 63.3 years, with a range of 45 to 77 years. All patients underwent complete resection including the chest wall combined resection. During the operation, plastic afterloading catheters fixed on the Vicryl mesh at interval of 1 cm were placed on the site of chest wall resection. From the third to sixth day after the operation, 15 to 32 Gy of radiation was delivered over 3 or 4 days using a high dose rate remote afterloading system. The area targeted for brachytherapy was determined by a computed tomography (CT) scanner translator with a computer program for radiation planning. The median postoperative hospital stay was 35 days. Local recurrences were observed in 2 patients, but there was no evidence of recurrence in the margin of the resected chest wall. We believe that this short period of treatment and the low side effects enhances the quality of the patients. Prevention of local recurrence was achieved in short term follow-up.
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伊藤, 祥隆 ; 小田, 誠 ; 太田, 安彦 ; 呉, 哲彦 ; 常塚, 宣男 ; 渡邊, 剛
概要:
金沢大学大学院医学系研究科血管病態制御学<br />症例は16歳, 男性.既往歴として4歳児に漏斗胸に対して胸骨翻転術を施行され, 14歳時にMarfan症候群と診断された.1994年に右自然気胸に対し胸腔鏡下肺部分切除術を施行した.199
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6年2月に右気胸を再発し保存的に加療したが, 同年4月に右気胸を再々発し, 小開胸下に肺部分切除術を施行した.1997年2月15日に左背部痛と呼吸困難が出現し, 当科を受診した.胸部レントゲン写真にて左自然気胸と診断した.胸腔ドレーンを留置して保存的に加療するも改善しないため, 2月20日胸腔鏡下手術を施行した.肺尖部にブラが多発しており, これを切除した.Marfan症候群は気胸の合併率が高く, 本例のように体格の成長に伴って気胸を繰り返し再発することもあり, 注意深い経過観察が必要と思われた. A case of bilateral recurrent pneumothrax in a patient with Marfan syndrome was reported. A 17-year-old male whose right pneumothorax had recurred twice during the past 3 years was admitted due to left pneumothorax complaining of chest pain and dyspnea. He was tall and thin with long tapered extremities, and echography revealed annulo-aortic ectasia. Air leakage continued inspite of left chest tube drainage followed by surgical treatment. Bullae were resected under VATS, and he was discharged 5 days later. Patients with Marfan syndrome should be observed carefully after operation because they frequently develop recurrent pneumothorax.
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太田, 安彦 ; 田村, 昌也 ; 飯野, 賢治 ; 常塚, 宣男 ; 新田, 香苗
概要:
癌性胸膜炎に対する腔内化学療法においては,長時間にわたる胸腔内での薬剤活性の維持が求められる.Paclitaxelの24時間胸腔内投与を含めた集学的治療の悪性胸水に対する治療成績につき中間報告する.方法.2001年10月から2004年5月ま
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でに,癌性胸膜炎と確診された10例に対して本治療を行なった.原発病巣は肺癌9例,乳癌1例.Paclitaxel(120 mg/m^2)24時間腔内投与を含む集学的治療を行なった.6例に対しては選択的に外科治療が,また9例に対しては全身化学療法が併用された.術式は肺部分切除+壁側胸膜切除(PL)2例,肺葉切除+PL2例,PL1例,胸壁切除+PL1例であった.結果.手術例においては術後平均7.7(3〜16)日目に腔内治療が施行された.Paclitaxel腔内投与に伴う副作用は10例中5例に認め,胸痛と白血球減少が頻度的には多かったが,重篤な副作用はみられず,5例においては副作用の発現は認めなかった.中間観察期間19ヶ月(3〜33ヶ月)にて,悪性胸水は8例において良好にコントロールされており,中間生存期間は18ヶ月であった.結語.症例数および観察期間ともなお蓄積が必要だが,paclitaxelを用いた長時間胸腔内治療は癌性胸膜炎に対する局所療法として新たな治療選択肢のひとつとなる可能性がある. Background. For successful intrapleural chemotherapy, efforts should be made to maintain the intrapleural drug activity as long as possible. In this interim report, the effectiveness of paclitaxel administered by 24-hour intrathoracic infusion as an adjunct to selective surgical management and/or systemic chemotherapy for controlling malignant pleural effusions is described. Methods. Between October 2001 and May 2004,10 patients with carcinomatous pleuritis were enrolled in the study. The primary sites of the diseases were the lung in 9 patients and the breast in one patient. Paclitaxel (120 mg/m^2) was administered by 24-hour intrathoracic infusion. Six of the 10 patients selectively underwent surgical treatment and 9 patients received adjuvant systemic chemotherapy. The operative procedures used were partial resection of the primary site plus parietal pleurectomy (PL) in 2 cases, lobectomy plus PL in 2 cases, PL only in one case, and chest wall resection plus PL in one case. Results. In patients who underwent surgery, the mean time interval between the operation and intrapleural chemotherapy was 7.7 days (range 3-16'days). Mild toxicity was found in 5 cases, and chest pain and neutropenia were dominant. During a median follow-up period of 19 months (range, 3-33 months), malignant effusions were successfully controlled in 8 patients and the median survival period was 18 months. Conclusion. The use of paclitaxel in this manner merits further investigation for possible intervention for malignant pleural effusions originating in lung and breast neoplasms.
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