A case of neuroendcrine tumor of the ileum with liver metastases treated with transcatheter arterial chemoembolization with degradable starch microspheres and biotherapy with octreotide

症例は50歳代女性.健診の腹部超音波検査で多発肝腫瘤を指摘され当院を受診.ダブルバルーン小腸内視鏡で回腸に多発する腫瘤性病変を認め,生検により,回腸原発神経内分泌腫瘍の多発肝転移と診断された.肝転移病巣に対し,微小デンプン球(degradable starch microspheres:DSM)とリピオドールを用いた肝動脈化学塞栓療法を施行し,良好な腫瘍縮小効果を認めた.さらに,術後に持続性ソマトスタチンアナログマイクロスフェア型徐放性製剤 (オクトレオチド酢酸塩徐放性製剤:商品名:サンドスタチンLAR筋注用)を継続投与し,長期間にわたる腫瘍の増殖抑制効果を維持し得た.切除不能の消化管神経内分泌腫瘍の肝転移症例に対する治療法として有用であると考えられた.

We report a case of neuroendocrine tumor of the ileum with liver metastases. A 50 year-old level woman was pointed out multiple liver tumors by the abdominal ultrasonography and admitted to our hospital. Histological diagnosis was neuroendocrine tumor G1 (WHO classification) on tumor biopsy of the liver. Multiple ileum tumors were found on endoscopic examination of the ileum using double balloon endoscopy and assessed as a primary lesion. Transcatheter arterial infusion chemotherapy using iodized oil (lipiodol) and degradable starch microspheres (Lip-TAI using DSM) was performed for the metastatic lesion of the liver, and tumor regression was observed. Long-acting somatostatin analogue (octreotide) was administered once a month as an additional therapy. Inhibition of the tumor proliferation in both primary and metastatic lesion was observed for about 2 years. Combination therapy with Lip-TAI using DSM and biotherapy with octreotide will be a promising therapy for unresectable neuroendocrine tumor with liver metastases.

微小デンプン球

神経内分泌腫瘍

肝転移

オクトレオチド

肝動脈化学塞栓術