ANALYSIS OF RADIOTHERAPY FOR LUMBOSACRAL CARCINOMATOUS NEUROPATHY Masatoshi TANIGUCHI, Yuko KANEYASU, Kumiko KARASAWA, Noboru FUKUHARA Makiko TANAKA,
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1 ANALYSIS OF RADIOTHERAPY FOR LUMBOSACRAL CARCINOMATOUS NEUROPATHY Masatoshi TANIGUCHI, Yuko KANEYASU, Kumiko KARASAWA, Noboru FUKUHARA Makiko TANAKA, Midori KITA-Okawa, Tomohiko OKAWA (Received 8 December 1995, accepted 13 February 1996) Abstract: Thirty one patients with lumbosacral carcinomatous neuropathy were treated by radiotherapy at Tokyo Women's Medical College from February 1981 to February The most common primary site was colorectum (20 cases) and followed by uterine cervix (6 cases). Treatment procedures were radiotherapy alone, radiotherapy and chemotherapy, and radiotherapy after surgery, and we had 13 cases, 17 cases and 1 case for each procedure, respectively. Pain relief after radiotherapy was obtained in 24 cases (77.4%). The median duration of pain relief was 5 months. Tumor response after treatment were CR in 3 cases and PR in 11 (CR+PR: 45.2%). There was no relationship between tumor response rate and total dose or tumor size. The fifty percent survival after radiotherapy was 14 months and the 1, 2 and 5 year cumulative survival rate were 58.2%, 13.1% and 6.5%, respectively. There were no severe side effects or complications. This analysis suggests that radiotherapy is usefull for the patients with lumbosacral carcinomatous neuropathy. Key Words: Lumbosacral carcinomatous neuropathy, Radiotherapy Division of Clinical Oncology, Department of Radiology, Tokyo Women's Medical College (8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN)
2 Table 1. Patient Characteristics
3 Lumbosacral Nochange(NC):症 carcinomatous 状 が50%以 neuropathyに 下 とな ら な い 対 す る放 射 線 治 療 の 検 討 用1例 で あ っ た.外 が軽 減 も し くは不 変 で,薬 10MV X線 剤 投 与 量 が不 変 も し くは増 400cGyに 量 した もの. 74.8Gy,平 放 射 線 治 療 前 の疼 痛 に対 す る治 療 は 非 麻 薬 性 鎮 痛 薬 が 最 も多 く15例,次 い で 麻 薬 の7例,非 又 は60Coγ て 週3 5日 あ っ た.照 射 を 併 用 し,照 治 療 子 宮 頸 癌5例 射 野 は 未 治療 に対 して は 腔 内照 学 療 法 併 用17例 経 動 脈 静 脈 的 も し くは 経 口 的 に,持 間 歌 的 にfluorouracil mitomycin 治 療 方 法 は放 射 線 治 療 単 独13例,放 射 線 治療 と化 学 療 法 併 用17例,手 術療 法後放射線治療併 Fig. 1 Type of Tumor Localization calcium leucovorin peplomycin cyclophosphamide doxifluridineが Table 2a. Primary site and Tumor Localization I: iliopsoas muscular type, II: piriform muscular の他 は 射 線 量 は 外 部 照 射 と腔 内照 射 に よ る 総A点 線 量 で 示 し た.化 2.方 法 ら 骨 盤 内 腫 瘍 の み が 充 分 含 ま れ る よ う限 局 して設 れ ぞ れ2例,非 は 無 治療 で あ っ た. 線 量 は20Gyか に 対 し て は 全 骨 盤 照 射,そ 定 し た.未 麻 薬 性 鎮 痛 薬 神 経 ブ ロ ッ ク併 ニ ア ッ ク 線 を 用 い 一 回 線 量150 行 い,総 均47.1Gyで 子 宮 頸 癌5例 麻 薬 性 鎮 痛 薬 補 助 薬 併 用,神 経 ブ ロ ッ クが そ 用 が1例 で あ っ た.4例 部 照 射 は,リ type, III: sacrococcygeal type は 続 または C cisplatin sulfate 投 与 され てい
4 Table 2b. Symptoms and Tumor Localization I: iliopsoas muscular type, II: piriform muscular type, III: sacrococcygeal type Table 3a. Pain Relief by Tumor Localization I: iliopsoas muscular type, II: piriform muscular type, III: sacrococcygeal type CR: complete relief, PR: partial relief, NC: no change
5 Table 3b. Pain Relief by Treatment Procedure CR: complete relief, PR: partial relief, NC: no change Rad: radiotherapy, C: chemotherapy, S: surgery Table 3c. Pain Relief by Radiation Dose CR: complete relief, PR: partial relief, NC: no change Fig. 2 Pain relief by Tumor Size and Radiation Dose
6 Table 4a. Tumor Response by Tumor Size CR: complete response, PR: partial response, NC: no change PD: progressive disease Table 4b. Tumor Response by Tumor Localization I: iliopsoas muscular type, II: piriform muscular type, III: sacrococcygeal type CR: complete response, PR: partial response, NC: no change PD: progressive disease Table 4c. Symptoms and Tumor Localization CR: complete response, PR: partial response, NC: no change PD: progressive disease
7 Fig. 4a Cumulative Survival Curve Fig. 4b Cumulative Survival Curve by Tumor Response Table 5. Side Effects Fig. 3 Tumor Response by Tumor Size and Radiation Dose BM: bone marrow
8 1) Ampil, F. L.: Palliative irradiation of lumbosacral plexus neuropathy. Int.J.Radiat.Oncol. Biol. Phys. 12: , ) Jaeckle, K. A., Young, D. F., Foley, K. M. : The natural history of lumbosacral plexopathy in cancer. Neurologv 35: 11-15, ) Gaeta, M., Pandolfo, I., Russi, E, et al.: Pelvic carcinomatous neuropathy: CT Findings and implications for radiation treatment planning. J. Comput. Assist. Tomogr. 12: , ) Overgaard, M., Overgaard, J., Sell, A.: Dose-response relationship for radiation therapy of recurrent,
9 residual and primarily inoperable colorectal cancer. Radiother Oncol 1: , ) Thomas, J. E., Cascino, T. L., Earle, J. D.: Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology 35: 1-7, ) Buhier, H., Seefeld, U., Deyhle, P, et al.: Endoscopic follow-up after colorectal cancer surgery. Early detection of local recurrence? Cancer 54: , ) Russi, E., Pergolizzi, S., Gaeta, M, et al. Palliative- Radiotherapy in lumbosacral carcinomatous neuropathy. Radiotherapy and Oncology, 26: , 1993
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第 60 回 医 療 者 がん 研 修 会 2015/9/17 もっと 知 りたい 膀 胱 癌 治 療 尿 管 癌 膀 胱 癌 の 化 学 療 法 広 島 市 立 広 島 市 民 病 院 泌 尿 器 科 副 部 長 弓 狩 一 晃 泌 尿 器 科 での 化 学 療 法 経 尿 道 的 投 与 経 静 脈 動 脈 的 投 与 膀 胱 癌 治 療 1 表 在 癌 経 尿 道 的 膀 胱 腫 瘍 切 除
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日本消化器外科学会雑誌第31巻第7号
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1) Michaelis L. Biochem Z., 59, 78, 1914. 2) Ferris H. C. Dent. Cosmos Phila., 63, 10, 93, 1921. 3) Bloomfield A. L. Bull Johns Hopk. Hosp. Bait., 31, 118, 1920. 4) Starr H. C. J. Biol. Chem. Bait., 54,
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