臨牀消化器内科 Vol.16 No.5(5)


特集名 消化器悪性腫瘍に対する化学療法
題名 肝癌・胆道癌・膵癌の化学療法
発刊年月 2001年 05月
著者 古瀬 純司 国立がんセンター東病院肝胆膵内科
著者 丸 泰司 国立がんセンター東病院肝胆膵内科
著者 吉野 正廣 国立がんセンター東病院肝胆膵内科
【 要旨 】 肝・胆道・膵癌における化学療法は一般に遠隔転移を有する進行癌に行われている.現在まで十分確立した治療法はみられず,臨床試験として行われているのが現状である.とくに肝細胞癌,胆管細胞癌では現在のところ有効な治療法は認められていない.胆道癌では5-FUを含む多剤併用療法で比較的高い奏効率が得られており,奏効例では予後の改善が期待される.膵癌では局所進行例で5-FUによる放射線化学療法が標準的治療法として確立しており,より効果的な照射法や新たな薬剤の検討が期待される.遠隔転移例ではgemcitabinが5-FUとの無作為比較試験により有効性が認められ,症状緩和効果からもその有用性が認められている.
Theme Chemotherapy for Gastrointestinal Malignancy
Title Chemotherapy for Hepato-Biliary and Pancreatic Carcinoma
Author Junji Furuse Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
Author Yasushi Maru Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
Author Masahiro Yoshino Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
[ Summary ] With hepatobiliary pancreatic cancer, there is no regimen of systemic chemotherapy, which has shown definite clinical benefits. Most chemotherapies have been performed as clinical trials. No usefulness has been certified in any clinical trial of systemic chemotherapy for hepatocellular carcinoma or cholangiocellular carcinoma. The widely used combination regimens in biliary tract cancer have been based on 5-fluorouracil (5-FU), and they have been reported to have relatively high response rates. There is hope that such a combination of chemotherapies may improve survival rates. In locally advanced pancreatic carcinoma, chemoradation therapy, using 5-FU, has widely been performed as a standard treatment. The clinical trials of a more effective irradiation method and/or new medical agents have been conducted to improve survival rates. In advanced pancreatic carcinoma with distant metastasis, gemcitabine has recently appeared to have promise in a randomized trial with 5-FU. Gemcitabine is more effective than 5-FU in alleviation of some disease-related symptoms; pain, performance status, and weight loss. It also has an advantage for survival rates.
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