臨床外科72巻10号

2017年10月発行

特集 Conversion Surgery—進行消化器がんのトータル治療戦略 がん種別Conversion Surgeryの戦略

消化器NET

著者： 増井俊彦¹ 穴澤貴行¹ 高折恭一¹ 上本伸二¹

所属機関： ¹京都大学大学院医学研究科肝胆膵・移植外科

ページ範囲：P.1235 - P.1240

【ポイント】
◆消化器NETに対するconversion surgeryの長期成績について，高いレベルのエビデンスはない．
◆現在のところ本邦ではNETに対する縮小効果の高い治療法がないことから，conversionに至る症例は多くないが，conversion surgeryに至った症例は根治切除例と同等の成績が報告されている．
◆非切除因子に着目して治療を進め，非切除因子が消失した段階に至ったタイミングで切除を考慮する必要がある．

参考文献

1）Yao JC, Hassan M, Phan A, et al：One hundred years after “carcinoid”：epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26：3063-3072, 2008

2）Ito T, Igarashi H, Nakamura K, et al：Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan：a nationwide survey analysis. J Gastroenterol 50：58-64, 2015

3）Kulke MH, Shah MH, Benson AB, 3rd, et al：Neuroendocrine tumors, version 1.2015. J Nat Compr Canc Netw 13：78-108, 2015

4）Pape UF, Jann H, Muller-Nordhorn J, et al：Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors. Cancer 113：256-265, 2008

5）van Vliet EI, van Eijck CH, de Krijger RR, et al：Neoadjuvant Treatment of Nonfunctioning Pancreatic Neuroendocrine Tumors with［177Lu-DOTA0, Tyr3］Octreotate. J Nucl Med 56：1647-1653, 2015

6）Barber TW, Hofman MS, Thomson BN, Hicks RJ：The potential for induction peptide receptor chemoradionuclide therapy to render inoperable pancreatic and duodenal neuroendocrine tumours resectable. Eur J Surg Oncol 38：64-71, 2012

7）Kwekkeboom DJ, de Herder WW, Kam BL, et al：Treatment with the radiolabeled somatostatin analog［177 Lu-DOTA 0, Tyr3］octreotate：toxicity, efficacy, and survival. J Clin Oncol 26：2124-2130, 2008

8）Devata S, Kim EJ：Neoadjuvant chemotherapy with capecitabine and temozolomide for unresectable pancreatic neuroendocrine tumor. Case Rep Oncol 5：622-626, 2012

9）Perysinakis I, Aggeli C, Kaltsas G, et al：Neoadjuvant therapy for advanced pancreatic neuroendocrine tumors：an emerging treatment modality? Hormones 15：15-22, 2016

10）Dumont F, Goudard Y, Caramella C, et al：Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension. World J Surg 39：1974-1980, 2015

11）Ezziddin S, Lauschke H, Schaefers M, et al：Neoadjuvant downsizing by internal radiation：a case for preoperative peptide receptor radionuclide therapy in patients with pancreatic neuroendocrine tumors. Clin Nucl Med 37：102-104, 2012

12）Sowa-Staszczak A, Pach D, Chrzan R, et al：Peptide receptor radionuclide therapy as a potential tool for neoadjuvant therapy in patients with inoperable neuroendocrine tumours（NETs）. Eur J Nucl Med Mol Imaging 38：1669-1674, 2011

13）Scigliano S, Lebtahi R, Maire F, et al：Clinical and imaging follow-up after exhaustive liver resection of endocrine metastases：a 15-year monocentric experience. Endocr Relat Cancer 16：977-990, 2009

14）Saxena A, Chua TC, Sarkar A, et al：Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms（NENs）supports an aggressive surgical approach. Surgery 149：209-220, 2011

15）Yao JC, Shah MH, Ito T, et al：Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 364：514-523, 2011

16）Yao JC, Fazio N, Singh S, et al：Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract（RADIANT-4）：a randomised, placebo-controlled, phase 3 study. Lancet 387：968-977, 2016

17）Raymond E, Dahan L, Raoul JL, et al：Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 364：501-513, 2011

18）Pavel ME, Baudin E, Öberg KE, et al：Efficacy of everolimus plus octreotide LAR in patients with advanced neuroendocrine tumor and carcinoid syndrome：final overall survival from the randomized, placebo-controlled phase 3 RADIANT-2 study. Ann Oncol, Apr 24, 2017

19）Strosberg J, El-Haddad G, Wolin E, et al：Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 376：125-135, 2017