前立腺における 神経内分泌癌(NE癌)の2症例

(NE
)2
2NS
• ',"$)
+PSA
(1202%&-&%.
!((,*'
#$/
•
18808
• -83
• 8IPSA5<:1%.
88Gleason score 5+5=10
88=288/8
88CT/MRI/4@HBK4I*4LN/&(T4N1M1)
7
8'+"94/&9FHC(/&=.;
DGEH!986!(OQMNLMP)3?JA,
86!$#<
)!0>.
• • $"%$6/
• ()
• #%!%()
PSA0.34 ng/ml
NSE65.7 ng/ml
CEA116.9 ng/ml
MRI
T2
High-b DWI
Low-b DWI
ADC map
• #'3
7K6)4)#LHDRM18Gy/2
)H,
7KI?#(EBRTM37.5Gy)H
7K#7J>?"G:
77CT>$*0%H.A8(5
77!#?CE!:-;815
7K151J>&@/
77CT>*0%9D@+H.A=
775#<FB5I?2
PSA
CEA
4
5
6
0.34
0.21
0.06
<0.01
<0.01
19.5
116.9
49.3
33.0
99.8
348.2
19.2
65.7
27.2
30.5
84.6
129.9
4.20
14.1
NSE
CA19-9
1
2
3.41
9
12
CA125
11
AFP
2
(MAB)
()
3 (37.5Gy)
HDR
(18Gy)
9
13
!
"
CT
(
)
(
)
•
27407
• -7<9
• 7JPSA(13.5)=:3%.
7J'+C,
77Gleason score 5+4=9
77>475/8
77CT/MRI/5DIEK 0&?/@B<8(T3N0M0)
6
77J'+">.;FHGI!C2
(A())
77J!$#=*!1.
• +#(-,
• +/4164+264750ml/
+*+++++* +-,
• $%"(
)
+*#(-,
• $ 3606(
)
PSA+0.73 ng/ml
NSE+15.6 ng/ml
• &
5)'(HDR718Gy/2).!
5
(EBRT).!
MRI
T2
High-b DWI
Low-b DWI
ADC map
PSA
NSE
12.4
2
3
5
6
7
10
12
14
13.5
14.01
15.52
3.02
0.76
0.39
0.73
0.25
10.4
15.6
12.5
(MAB
)
(18Gy)
=3<)3&,$^HDR
(high dose rate brachytherapy)
• 16L!/L3&(192Ir:V\YW[]UC#,
2LNDT $
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C>8(05>74>;KJ)MK3U%
RETFP>'LQT+U%HAT
HDR)
(EBRT)
PTV : 2.53.0Gy/fx
PTV : GTV+10mm
10mm
40Gy~45Gy/15~16fx/16days
%.
)
1.%(*111)#)+95~98%
2./0-%()&%1&1
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4.
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6.(neuroendocrine carcinoma2NE)
7.
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• -"*DGEI(;H=@
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!3%(#1
• +-3+$21(
6G<A5> +3
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• 7HE8F@IAJNSEJ9?C=B4:I+/0
$21
(NE
)
(HE)
8<*4(NE4)Z@6-
• 51t5.'["
KGH;:XNE4(67%)IB#R_?4WNE4S,
(19%)J*3+YNE4S5.(14%)
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• )3t3+(CDDPrCPT-11rVP-16)L =3
+Mcphogp
b(TUQ`Ljnlp)3
VNa
• tB!#YEA4SOM7&FVDY
TLT\T\C9bPM/&FG9.8~17.1q$
• 8:9<(+),24PSA#
&( 5%*"3).
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7;=:)$'*!5
• "3-NE0-.)$+
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• PSA
(NE)2