An Elderly Case of Small-Cell Lung Cancer Treated with Etoposide plus Carboplatin using Chatelut Formula

症例は81歳,男性.咳,労作時呼吸困難のため,近医を受診し胸部X線で両下肺野の網状影および右肺門縦隔リンパ節腫張を指摘され当科に入院した.入院後,右S9原発の進展型肺小細胞癌(T4N2M0)と診断した.高齢で肺気腫を伴い,腎機能もクレアチニンクリアランス31ml/分と低下が認められたが,Chatelut式を用いてAUC=5を目標とした第1日のカルボプラチンと第1-3日のエトポシド75mg/m^2による併用化学療法を行った.第1コース目に測定したカルボプラチンのAUCは目標よりやや低い4.42であったが,血液毒性はG-CSFの併用で耐用可能で4コースが施行され,効果は70%縮小の有効であった.自覚的な副作用も軽く,高齢・腎機能低下例においてもChatelut式を用いたこの治療法はG-CSFを併用すれば安全に施行可能なことが示唆された.An 81-year-old man was admitted to our hospital and complaining of cough and dyspnea. Chest X-ray and CT showed a consolidation in right S^8 and S^9, hilar and mediastinal lymph node swelling,and emphysema. Small-cell lung carcinoma (SCLC) was diagnosed by cytological examination of sputum and bronchial washing from the right B^9a. The clinical stage was evaluated for extensive disease (T4N2M0) . Because of his age and renal dysfunction, four cycles of combination chemotherapy with etoposide (75mgm^2, days 1-3) plus carboplatin (target AUC=5, day 1) using the Chatelut formula were performed. The total tumor volume was reduced to 30% and a partial response was achieved. Actual carboplatin AUC at the first cycle was 4.42mg.minml, which was slightly lower than the target AUC. Manageable bone marrow suppression in combination with G-CSF and less toxicity including renal injury, nauseavomiting,and appetite loss were observed. This regimen is potentially feasible and effective for elderly or renal function-impaired patients with SCLC