Docetaxel을 포함한 병합화학요법 후에 발생한 범발성 출혈성 대장염 1예
A case of extensive hemorrhagic colitis after docetaxel - based combination chemotherapy
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본 환자는 docetaxel 근간 화학요법 후 심한 출혈을 동반한 다발성 대장궤양이 발생하는치명적인 경과를 보였으나 경동맥 색전술 및 내시경적 지혈을 통한 적극적인 보존요법 후 수술하지 않고, 완전 회복을 보인 예로 docetaxel과 관련된 대장염으로는 국내 첫 보고이다. 따라서 단일 또는 병합요법으로 taxane계열 항암제를 사용한 후 급성 복부 통증, 직접 또는 반발 압통, 발열, 설사 또는 혈변이 있는 경우에는 이와 같은 대장염을 염두하고 복부 CT 등을 점검한 후 광범위 항생제 치료 및 필요 시 수술적 절제가 치명적인 경과를 예방할 수 있을 것으로 생각된다. 또한 이와 같은 대장염을 보인 환자에서 taxane 계열 항암제를 동일 용량으로 재사용한 경우 일부 환자에서는 비슷한 증상이 재발되었고, 감량하거나 다른 항암제로 변환하여 치료한 경우에는 재발하지 않았다는 보고를 고려해보면8) 치명적인 증상 발현 시에는 다음 치료로 약제 용량을 감량하거나 다른 약제로 바꾸어서 투여하는 것이 치명적인 합병증을 예방할 수 있을 것으로 보인다.
Abstract
Gastrointestinal complications are frequently followed by combination chemotherapy. Based on recent reports, colitis is very rare but serious complication associated with taxane based chemotherapy. Despite of aggressive management, clinical course of colitis associated with chemotherapy is potentially fatal. We report the first case in Korea who was developed extensive colitis after docetaxel-based chemotherapy. A man aged 58 years with recurrent oral cavity carcinoma received chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU). On the 7th day of first cycle of chemotherapy, he complained of abdominal pain and fever, followed by hypotension because of large amount of hematochezia. Abdominal CT and colonoloscopy revealed extensive pancolitis with bleeding. He underwent two times of transarterial embolization with microcoils and gelform. Nevertheless these managements, bleeding foci were remained. Then, colonoscopic hemostasis such as hemoclipping and epinephrine injection were performed and fully recovered after 6 weeks.(Korean J Med 70:207-212, 2006)
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