演題抄録

臓器別シンポジウム

開催概要
開催回
第56回・2018年・横浜
 

深刻な癌の中枢神経合併症:髄膜癌腫症とTrousseau症候群

演題番号 : SY16-4

[筆頭演者]
演者)髙橋 英明:1 
[共同演者]
五十川 瑞穂:1

1:新潟県立がんセンター新潟病院・脳神経外科

 

Advances in stereotactic radiotherapy and the appearance of molecular targeted therapy have brought about a good change not only in the palliation of the neurological symptoms but also in the prognosis of brain metastases. Advances in cancer treatment also revealed the difficulty in managing central nervous system (CNS) complications.
In the era of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy, treatment is effective for leptomeningeal carcinomatosis EGFR gene positive lung cancer, but there is no effective means for other histological lung cancer and other cancer types. Therefore, the therapeutic purpose of meningeal carcinomatosis is mainly management of hydrocephalus and increased intracranial pressure control. Because meningeal carcinomatosis has a variety of pathological conditions, it is difficult for oncologist to diagnosis.
Second, cerebral infarction associated with cancer is a devastating complication and is known as Trousseau syndrome. Although this cerebral thrombus complicates with advanced cancer, it sometimes occurs before diagnosis of cancer. Unfortunately, it is difficult to treat Trousseau syndrome due to the lack of indications for low molecular weight heparin and novel oral anticoagulants. If there is venous thrombosis, pulmonary embolism, or atrial fibrillation, an anti-Xa inhibitor can be used. In ordinal cerebral infarction, hemiplegia and aphasia are frequently observed, but in Trousseau syndrome, higher brain dysfunction such as apraxia and agnosia is characteristic. Often in this condition, D-dimer becomes a high value, and DIC is accompanied by consumption-dependent thrombocytopenia.
These two severe complications will have unfortunate consequences for patients and medical personnel. At this symposium, we present the problems of diagnosis and management for meningeal carcinomatosis and Trousseau syndrome.

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