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開催概要
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第56回・2018年・横浜
 

肺転移を伴うWilms腫瘍に全肺照射を併用せず高用量化学療法を施行した一例

演題番号 : P34-7

[筆頭演者]
演者)寺西 悠:1 
[共同演者]
浅沼 宏:1、嶋 晴子:2、田中 伸之:1、武田 利和:1、松本 一宏:1、森田 伸也:1、小坂 威雄:1、水野 隆一:1、篠島 利明:1、菊地 栄次:1、大家 基嗣:1

1:慶應義塾大学・泌尿器科、2:慶應義塾大学・小児科

 

Wilms tumor (WT) is the most common renal tumor in children over the age of 3 months.Favorable histology (FH) WT has a 5-year overall survival rate of >90%, and more than 80% children with stage IV WT are expected to survive. However, the long-term survivors of WT with pulmonary metastases are generally treated with whole lung radiation (WLR). Here, we report the case of a male infant diagnosed with stage IV FHWT with refractory pulmonary metastases.
A 5-month-old male presented with an asymptomatic abdominal mass that was detected. A stony hard mass was palpable on the right side of the abdomen over the midline. CT and PET revealed a unilateral right renal tumor with multiple pulmonary metastases. The right renal tumor was completely resected via surgery. The tumor was 9 cm in the longest diameter and was well encapsulated with para-aortic lymph node swelling. On POD 5, chemotherapy was initiated according to the National Wilms Tumor Study Group (NWTS)-5, DD-A4 protocol. On POD 9, 10.8-Gy/6-Fr radiotherapy to the flank was initiated. Because multiple pulmonary metastases were small and detected only on CT but not on chest radiography, WLR was not administered. At week 9, chest radiography and CT revealed multiple new pulmonary metastases, and the pulmonary metastases detected at the diagnosis had disappeared. In addition, peritoneal metastasis outside the abdominal radiation field was observed. Reduced ifosfamide, carboplatin, and etoposide (ICE) therapy was selected as intensive salvage chemotherapy. Following ICE therapy, the peripheral blood stem cells were harvested, 10.8-Gy radiation was delivered to the peritoneal metastasis and complete remission was confirmed using PET-CT. Finally, high-dose chemotherapy with melphalan, etoposide, and carboplatin as well as autologous peripheral blood stem cell transplantation were performed. No evidence of relapse has been noted since 4 years.

キーワード

臓器別:腎・尿路・膀胱

手法別:化学療法

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