Cyclophosphamide, vincristine, dacarbazineによる化学療法を行った悪性褐色細胞腫の一例と本邦報告例の文献的考察
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A 49-year-old woman had a right adrenalectomy for pheochromocytoma in April 1989. In May 1990 she underwent an operation to remove paraaortic lymph nodes, and the lymph nodes showed pheochromocytoma. Twenty-two months after the first operation, metastases to the left cervical nodes, lung, and liver occurred. Her blood pressure was 172/104 mmHg; fasting plasma glucose (FPG), 342mg/dl; urinary noradrenaline (NA), more than 2000μg/day; and plasma NA, 17.28ng/ml. Treatment with the CVD regimen (cyclophosphamide, 750mg/m<SUP>2</SUP> on day 1; vincristine, 1.4mg/m<SUP>2</SUP> on day 1; dacarbazine, 600mg/m<SUP>2</SUP> on days 1 and 2, every 21 days) was begun on February 14, 1991. After 3 cycles of the CVD regimen her blood pressure was 140/82mmHg; FPG, 157mg/dl; urinary NA, 917μg/dayl; and plasma NA, 4.54ng/ml. The size of the metastatic lesions in the liver had decreased. Treatment with the CVD regimen was continued until May 1992. After that she did not go to the hospital for about 2 months. Metastatic lesions progressed gradually and treatment with the CVD regimen was repeated again.<BR>She was admitted to the hospital on February 17, 1993 because of appetite loss and nausea. Her blood pressure was 188/94 mmHg; FPG, 197mg/dl; HbAic, 9.5%; urinary NA, 18265.3μg/day; and plasma NA, 47.20ng/ml. She was treated with the CVD regimen in 2 repeated cycles (28th cycle of treatment with the CVD regimen) but there was no effect. She died following hemoptysis on March 15, 1993.<BR>From January 1988 to December 1993, thirteen patients with malignant pheochromocytoma treated with the CVD regimen were reported in Japan. These fourteen cases, including the present patient, were reviewed. In these fourteen cases, the mean age was 39.3 years old (range, 16 to 64 years old) and there was a 9:5 male predominance. The CVD regimen produced a response rate of 50.0%. Stable disease in 1 patient, progressive disease in 2 patients and death in 4 patients were reported.<BR>Responding patients except for 2 patients were less than 40 years old. All patients under 40 were male and 2 patients over 40 years old were famale. The various levels of urinary or plasma catecholamines were reported. By the end of 3 to 10 cycles of the CVD regimen there was evidence of significant tumor regression or reduction of urinary or plasma catecholamines. Three of the four cases who died were patients over 40 years old with elevated levels of urinary or plasma NA. The remaining case was a 16-year-old youth with elevated levels of both plasma NA and adrenaline. These four cases had both lung and liver metastases. After temporary interruption, the CVD regimen became ineffective.<BR>Follow-up studies may determine appropriate dosage modifications of combination chemotherapy in patients with advanced, malignant pheochromocytoma.
- 一般社団法人 日本内分泌学会の論文
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- Cyclophosphamide, vincristine, dacarbazineによる化学療法を行った悪性褐色細胞腫の一例と本邦報告例の文献的考察