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要旨 内視鏡的治療の適応を超えたStage I食道癌に対する化学放射線療法(chemoradiotherapy ; CRT)の治療成績について検討した.当院のretrospectiveな解析では,1994年1月から2002年12月までに根治的CRTを行われたStage I食道扁平上皮癌は41例で,その効果はCR率87.8%,1年生存率97.5%,3年生存率79.4%,5年生存率66.9%であった.局所の遺残再発例に対しては,救済治療として内視鏡治療9例,外科切除3例が安全に実施できたが,CR36例中3例(8%)でCRT後の晩期毒性に起因すると思われる死亡が認められた.一方Japan Clinical Oncology Group(JCOG)での多施設共同第II相試験(JCOG9708)でもCR率96%,2年生存率93%と外科切除に匹敵するCRTの有効性が示され,Stage I食道癌に対するCRTの有効性を標準治療である外科切除と比較する第III相試験JCOG0502が間もなく開始予定である.
Treatment outcomes of definitive chemoradiotherapy for superficial esophageal carcinoma beyond the indications for endoscopic mucosal resection (EMR) were analyzed. There were 41 patients with stage I esophageal squamous cell carcinoma who underwent definitive chemoradiotherapy. Of the 41, 36 (87.8%) patients achieved a complete response with 1-, 3-, and 5-year survival rates of 97.5%, 79.4%, 66.9%, respectively. Salvage treatments, predominantly with EMR, were safely undergone for local residual/recurrent tumors. However, three (8%) of 36 CR patients died without cancer, which event might have been caused by late toxicity. A multi-institutional phase II study of definitive chemoradiotherapy for stage I esophageal cancer (JCOG9708) has resulted in good outcomes with a complete response rate of 96% and a 2-year survival rate of 93%. These results suggested that chemoradiotherapy might achieve outcomes comparable with radical surgery in this stage. A randomized trial comparing surgery with definitive chemoradiotherapy (JCOG0502) will soon be initiated.
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