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論文
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常塚, 宣男 ; 石川, 紀彦 ; 平沼, 知加志 ; 佐藤, 日出夫 ; 小田, 誠 ; 渡辺, 剛 ; Tsunezuka, Yoshio ; Ishikawa, Norihiko ; Hiranuma, Chikashi ; Sato, Hideo ; Oda, Makoto ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />From January 1997 to June 1999, we performed surgery in 17 patients with mycobacteria other than tub
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erculosis (MOTT), and 2 patients with lung cancer among them. Both patients had the diagnosis of MOTT by sputa bacterial cultures preoperatively, but no diagnosis of lung cancer. By computed tomography (CT) scanning, lung cancer was suspected in both patients, therefore they were performed video-assisted thoracoscopic resection of the lung. The diagnosis of malignancy was made by intraoperative frozen section of resected tissue, the patients were performed lobectomy with systematic mediiastinal lymph nodes dissection. According to increment of detection of the small peripheral lesion, infectious disease such as MOTT can be detected as small abnormal shadow by CT. However, it is difficult to distinguish malignancy from infectious disease preoperatively. Even if a preoperative diagnosis, of MOTT was made like present cases, diagnostic video-assisted thoracoscopic surgery must be performed, considering that lung cancer could combined with MOTT.
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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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