病理診断と画像所見に解離が見られた局所進行乳癌術前化学療法奏効例
局所進行乳癌に対しては集学的治療の施行が勧められ，術前化学療法(neoadjuvant chemotherapy, NAC) は最も重要な治療の1 つである．我々は，切除不能乳癌Stage IIIB 症例のNAC 奏効例を経験した．NAC 後のCT，MRI 等の画像診断による臨床診断では腫瘤残存を認めたが，手術後の病理ではわずかに腫瘍細胞集塊を認めるのみであり，組織学的治療効果判定はGrade 2b であった．局所進行乳癌に対するNAC の効果判定は，それ以後の治療方針に重要な影響を及ぼすが，画像による効果判定と病理学的効果判定は必ずしも一致しないことがある．...
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| Published in | 日大医学雑誌 Vol. 75; no. 2; pp. 99 - 103 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大学医学会
01.04.2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0029-0424 1884-0779 |
| DOI | 10.4264/numa.75.2_99 |
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| Abstract | 局所進行乳癌に対しては集学的治療の施行が勧められ，術前化学療法(neoadjuvant chemotherapy, NAC) は最も重要な治療の1 つである．我々は，切除不能乳癌Stage IIIB 症例のNAC 奏効例を経験した．NAC 後のCT，MRI 等の画像診断による臨床診断では腫瘤残存を認めたが，手術後の病理ではわずかに腫瘍細胞集塊を認めるのみであり，組織学的治療効果判定はGrade 2b であった．局所進行乳癌に対するNAC の効果判定は，それ以後の治療方針に重要な影響を及ぼすが，画像による効果判定と病理学的効果判定は必ずしも一致しないことがある． |
|---|---|
| AbstractList | 局所進行乳癌に対しては集学的治療の施行が勧められ，術前化学療法(neoadjuvant chemotherapy, NAC) は最も重要な治療の1 つである．我々は，切除不能乳癌Stage IIIB 症例のNAC 奏効例を経験した．NAC 後のCT，MRI 等の画像診断による臨床診断では腫瘤残存を認めたが，手術後の病理ではわずかに腫瘍細胞集塊を認めるのみであり，組織学的治療効果判定はGrade 2b であった．局所進行乳癌に対するNAC の効果判定は，それ以後の治療方針に重要な影響を及ぼすが，画像による効果判定と病理学的効果判定は必ずしも一致しないことがある． |
| Author | 秦, 重美 秦, 怜志 竹内, 英樹 篠原, 将彦 添田, 大司 田部井, 敏夫 朴, 英智 君塚, 圭 小林, 瑞絵 石塚, 美沙 天野, 芙美 渡邊, 慶史 |
| Author_xml | – sequence: 1 fullname: 田部井, 敏夫 organization: 川越三井病院 内科 – sequence: 1 fullname: 篠原, 将彦 organization: 川越三井病院 内科 – sequence: 1 fullname: 天野, 芙美 organization: 川越三井病院 内科 – sequence: 1 fullname: 秦, 重美 organization: 川越三井病院 内科 – sequence: 1 fullname: 小林, 瑞絵 organization: 川越三井病院 薬剤部 – sequence: 1 fullname: 君塚, 圭 organization: 春日部市立病院 乳腺外科 – sequence: 1 fullname: 石塚, 美沙 organization: 川越三井病院 看護部 – sequence: 1 fullname: 渡邊, 慶史 organization: 川越三井病院 外科 – sequence: 1 fullname: 秦, 怜志 organization: 川越三井病院 外科 – sequence: 1 fullname: 添田, 大司 organization: 川越三井病院 内科 – sequence: 1 fullname: 朴, 英智 organization: 川越三井病院 外科 – sequence: 1 fullname: 竹内, 英樹 organization: 埼玉医科大学国際医療センター 乳腺腫瘍科 |
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| References | 10) Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recom mendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol 2006; 24: 1940-1949. 16) Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol 2003; 181: 1275-1282. 9) 乳癌診療ガイドライン 治療編 2015 年版 13) Nakamura S. Present role and future perspectives of the evaluation of the effect of primary chemotherapy by breast imaging. Breast Cancer 2004; 11: 134-138. 5) Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemo ther apy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 2008; 26: 778-785. 8) Buzdar AU, Valero V, Ibrahim NK, et al. Neoadjuvant therapy with paclitaxel followed by 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy and concurrent trastuzumab in human epidermal growth factor receptor 2-positive operable breast cancer: an update of the initial randomized study population and data of additional patients treated with the same regimen. Clin Cancer Res 2007; 13: 228-233. 3) Van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 2001; 19: 4224-4237. 6) Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 2007; 25: 4414-4422. 2) Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998; 16: 2672-2685. 15) Belli P, Costantini M, Malaspina C, et al. MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy. 2006; 61: 946-953. 12) McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Int J Radiat Oncol Biol Phys 2007; 68: 1004-1009. 1) Mauri D, Pavlidis N, Ioannidis JP, et al. Neoadjuvant versus adjuvant systemic treatment in breast cancer: A metaanalysis. J Natl Cancer Inst 2005; 97: 188-194. 7) Smith IC, Heys SD, Hutcheon AW, et al. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 2002; 20: 1456-1466. 11) Buchholz TA, Tucker SL, Moore RA, et al. Importance of radiation therapy for breast cancer patients treated with high-dose chemotherapy and stem cell transplant. Int J Radiat Oncol Biol Phys 2000; 46: 337-343. 14) Hylton N. MR imaging for assessment of breast cancer response to neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am 2006; 14: 383-389. 17) Von Minckwitz G, Untch M, Blohmer J-U, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 2012; 30: 1796-1804. 4) Estevez LG, Gradishar WJ. Evidence-based use of neoadjuvant taxane in operable and inoperable breast cancer. Clin Cancer Res 2004; 10: 3249-3261. |
| References_xml | – reference: 7) Smith IC, Heys SD, Hutcheon AW, et al. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 2002; 20: 1456-1466. – reference: 15) Belli P, Costantini M, Malaspina C, et al. MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy. 2006; 61: 946-953. – reference: 2) Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998; 16: 2672-2685. – reference: 13) Nakamura S. Present role and future perspectives of the evaluation of the effect of primary chemotherapy by breast imaging. Breast Cancer 2004; 11: 134-138. – reference: 8) Buzdar AU, Valero V, Ibrahim NK, et al. Neoadjuvant therapy with paclitaxel followed by 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy and concurrent trastuzumab in human epidermal growth factor receptor 2-positive operable breast cancer: an update of the initial randomized study population and data of additional patients treated with the same regimen. Clin Cancer Res 2007; 13: 228-233. – reference: 17) Von Minckwitz G, Untch M, Blohmer J-U, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 2012; 30: 1796-1804. – reference: 11) Buchholz TA, Tucker SL, Moore RA, et al. Importance of radiation therapy for breast cancer patients treated with high-dose chemotherapy and stem cell transplant. Int J Radiat Oncol Biol Phys 2000; 46: 337-343. – reference: 14) Hylton N. MR imaging for assessment of breast cancer response to neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am 2006; 14: 383-389. – reference: 4) Estevez LG, Gradishar WJ. Evidence-based use of neoadjuvant taxane in operable and inoperable breast cancer. Clin Cancer Res 2004; 10: 3249-3261. – reference: 1) Mauri D, Pavlidis N, Ioannidis JP, et al. Neoadjuvant versus adjuvant systemic treatment in breast cancer: A metaanalysis. J Natl Cancer Inst 2005; 97: 188-194. – reference: 16) Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol 2003; 181: 1275-1282. – reference: 6) Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 2007; 25: 4414-4422. – reference: 12) McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Int J Radiat Oncol Biol Phys 2007; 68: 1004-1009. – reference: 5) Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemo ther apy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 2008; 26: 778-785. – reference: 10) Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recom mendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol 2006; 24: 1940-1949. – reference: 9) 乳癌診療ガイドライン 治療編 2015 年版． – reference: 3) Van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 2001; 19: 4224-4237. |
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| Snippet | 局所進行乳癌に対しては集学的治療の施行が勧められ，術前化学療法(neoadjuvant chemotherapy, NAC) は最も重要な治療の1 つである．我々は，切除不能乳癌Stage IIIB 症例のNAC 奏効例を経験した．NAC 後のCT，MRI... |
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| Title | 病理診断と画像所見に解離が見られた局所進行乳癌術前化学療法奏効例 |
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