SUCCESSFUL TREATMENT OF AN AFP-PRODUCING PANCREATIC CANCER PATIENT

成功治療產生甲種胎兒蛋白之胰臟癌

李唯揚(Wei-Yang Lee) ； 張東浩(Tung-Hao Chang) ； 黃家俊(Chia-Chun Huang) ； 劉幕台(Mu-Tai Liu) ； 畢祖平(Chu-Ping Pi) ； 洪儷中(Li-Chung Hung) ； 周采薇(Tsai-Wei Chou)

《放射治療與腫瘤學》 24卷1期 (2017/03) Pp. 57-65

https://doi.org/10.6316/TRO/201724(1)57

摘要

Introduction : Alpha-fetoprotein (AFP), a plasma protein produced by the fetal hepatocytes, yolk sac cells and some fetal gastrointestinal cells, is the tumor marker mostly used for the screening of hepatocellular carcinoma (HCC). However, AFP is not only elevated in HCC, but also in some rare cancers, such as germ cell tumors and, even more rarely, in AFP-producing pancreatic, gastric, colon and lung cancers. The incidence of elevated serum levels of AFP in pancreatic carcinomas has been reported to be 2.1%–24.0%. Most of the AFP-producing pancreatic cancers are pancreatoblastomas occurring in children or acinar cell carcinomas. The mean age of AFP-producing pancreatic cancers was among 50 years old. Case report : We reported a 64y/o male, with AFP-producing pancreatic cancer, ductal adenocarcinoma, diagnosed and treated by near total pancreatectomy and adjuvant concurrent chemo-radiotherapy (CCRT) in Oct. 2011. The patient completed the treatment course of CCRT. There was neither local nor regional recurrence in the image survey, during the 4 years follow-up. The AFP level decreased after CCRT treatment course started, and the AFP level was around 2 ng/ml thereafter, confirmed by the quarterly laboratory examinations. Discussion : In this reported rare case of, ductal adenocarcinoma, stage Ib, good treatment response was achieved with near total pancreatectomy and adjuvant CCRT in the four years follow-up so far, without any severe side effect. However, this may benefit from the early detection and early treatment. More patients were warranted to define the optimal treatment for AFP-producing pancreatic cancer.

關鍵字

Alpha-fetoprotein-producing pancreatic cancer ； Pancreatic adenocarcinoma ； Concurrent chemo-radiotherapy

並列摘要

前言：甲種胎兒蛋白是一種由胎兒的肝臟、卵黃囊和部分消化道細胞所製造的血漿蛋白，並且同時是一種常用於肝細胞癌的腫瘤標誌。然而並不只有肝細胞癌會導致血液中甲種胎兒蛋白濃度上升，在某些罕見的癌症也會導致，比方說生殖細胞瘤；而在某些更罕見的情況下，會因胰臟癌、胃癌、大腸癌或肺癌導致甲種胎兒蛋白濃度上升。胰臟癌導致血液中甲種胎兒蛋白濃度上升的比例，根據研究報告指出大概在 2.1%到 24%之間。大部分產生甲種胎兒蛋白之胰臟癌是孩童的胰母細胞瘤或是胰臟腺胞細胞癌。產生甲種胎兒蛋白之胰臟癌病人平均年齡約為五十歲。病例報告：一位罹患產生甲種胎兒蛋白之胰臟管腺癌的 64 歲男性，在 2011 年的年中被診斷出，並在之後緊接著接受近全胰切除術、於 10 月合併輔助性化學及放射線治療。在治療結束的四年後，根據影像學上的追蹤發現沒有局部或淋巴引流區復發。血液中甲種胎兒蛋白濃度在開始治療後即下降，並在之後每三個月的血液報告中維持在 2 ng/ml左右。討論：在這個罕見的第 1b 期產生甲種胎兒蛋白之胰臟管腺癌病人身上，病患接受近全胰切除術，及後續給予輔助性合併化學及放射線治療在到目前為止的四年中，追蹤發現有不錯的治療效果；這可能是因為早期診斷早期治療。不過我們仍需要更多的案例才能決定出最適當的治療方式。

並列關鍵字

產生甲種胎兒蛋白之胰臟癌 ； 胰腺癌 ； 合併化學及放射線治療