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A 60-year-old man presented with postoperative recurrence of intrahepatic cholangiocarcinoma with right portal vein tumor thrombosis (PVTT). After failure of standard chemotherapy, a liver biopsy showed that his microsatellite instability (MSI) status was high. Treatment with the immune checkpoint inhibitor (ICI) pembrolizumab was commenced, which resulted in a partial response and resolution of the PVTT. There were no significant immune-related adverse events. According to recently published reports, the frequency of MSI-high biliary tract cancer (BTC) is about 0%-2.1%, which is extremely rare. However, ICIs may be effective in patients with MSI-high BTC, such as the present patient.

It is very difficult to treat patients with liver metastasis presenting with jaundice or cachexia. We herein report a successfully treated case of huge liver metastasis of gastrointestinal stromal tumor (GIST) that initially showed jaundice and cachexia. The patient was a woman in her early 40 s. She had a history of duodenal GIST 4 years before this admission. She was admitted to our hospital for abdominal fullness and anorexia. Abdominal computed tomography revealed huge liver metastasis of GIST. She showed jaundice and cancer cachexia with a modified Glasgow Prognostic Score of 2. After applying nutritional support, 400 mg of imatinib was administered. Although leg edema transiently worsened, the withdrawal of imatinib and administration of diuretics improved it. Imatinib was re-administered, and nutritional support was continued. The total bilirubin level decreased, and the serum albumin level increased. The tumor gradually decreased in size. Finally, she received surgical resection after 16 months of treatment with imatinib. Although adjuvant imatinib administration was continued after surgery, and no recurrence was observed as of 18 months after surgery.

【背景と目的】 放射線治療を受けている乳がん患者の気持ちを明らかにした研究が少ない. そこで乳がん患者の放射線治療経過に伴う気持ちの変化を明らかにし, 看護支援を検討する. 【対象と方法】 研究参加に同意の得られた放射線治療を受けた乳がん患者6名で, 半構成的面接法及び看護記録, 診療記録からデータを収集した. 質的帰納的手法により患者の気持ちに関する言語をコード化し, 類似性に沿ってサブカテゴリー・カテゴリー化へと抽象化した. 【結果】 放射線治療開始時の気持ちは「がんと放射線治療の受容」「がんと放射線治療の苦悩」「家族や仲間に求める癒し」「病気回復と医療への期待」, 放射線治療中間時は「放射線治療を生活の一部として受容」「放射線治療を受けている苦悩」「他者との関係における心強さ」「将来への不安と希望」, 放射線治療終了時は「放射線治療が終了した安堵感と将来への希望」「症状・副作用・再発に対する苦悩」「他者から受けたサポートへの感謝」「医療・医療従事者への要望」というカテゴリーが明らかになった. 【結語】 放射線治療を受ける乳がん患者への看護支援は, 気持ちの葛藤に合わせた情報の提供と適切な技術の提供が重要であることが示唆された.

MK615, a compound extracted from the Japanese apricot “Prunus mume” has been reported to have in vitro anti-tumor activities against several cancer cell lines, including hepatocellular carcinoma (HCC). However, the clinical effects and feasibility of administering MK615 for patients with HCC were unknown. We experienced a case with advanced HCC for which MK615 was effective against both lymph node and pulmonary metastases. A 60-year-old female underwent surgical resection of a 9 cm HCC in the right lobe. The pathological diagnosis was moderately differentiated HCC with vascular invasion. The HCC recurred in the liver 8 mo after the surgery. Radiofrequency ablation and transarterial infusion chemotherapy were performed, but the recurrence was not controlled. One year after the intrahepatic recurrence, pulmonary and lymph metastasis appeared. Sorafenib was administered, but was not effective. Then, MK615 was administered as a final alternative therapy after informed consent was obtained from the patient. Three months later, her alpha-fetoprotein level decrease and both the lymph node and pulmonary metastases decreased in size. The patient has survived for more than 17 mo after the MK615 administration, and was in good condition. Although further investigations are necessary to clarify its safety and efficacy in humans, MK615 may be useful for the treatment of HCC, without serious adverse effects.