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Stomach and Intestine(Tokyo) Volume 38, Issue 3 （March 2003）

胃と腸 38巻3号（2003年3月発行）

Japanese English

今月の主題食道癌と他臓器重複癌―EMR時代を迎えて

主題

食道癌放射線化学療法施行例の他臓器重複癌 Multiple Primary Malignant Neoplasms in Patients Treated with Definitive Chemo-radiotherapy for Esophageal Cancer 山下啓史 ¹ , 武藤学 ¹ , 大津敦 ¹ , 目良清美 ¹ , 土井俊彦 ¹ , 佐野寧 ¹ , 吉田茂昭 ¹ Keishi Yamashita ¹ , Manabu Muto ¹ , Atsushi Ohtsu ¹ ¹国立がんセンター東病院消化管内科 ¹Division of Gastrointestinal Oncology and Endo- scopy, National Cancer Center Hospital East キーワード：食道癌 , 放射線化学療法 , 他臓器重複癌 , 胃癌 , 頭頸部癌 Keyword: 食道癌 , 放射線化学療法 , 他臓器重複癌 , 胃癌 , 頭頸部癌 pp.307-315

発行日 2003年3月25日 Published Date 2003/3/25

DOI https://doi.org/10.11477/mf.1403100879

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参考文献 Reference

　当院で根治目的放射線化学療法(chemoradiotherapy ; 以下CRT)が施行された他臓器重複癌(重複癌)合併食道癌症例44例について，頻度や治療法およびその治療成績を報告した．重複癌の発見時期は同時性が34例，antecedent tumorが8例，subsequent tumorが8例であった．

部部位でみると，胃24(43.6％)，頭頸部17(30.9％)，大腸4(7.3％)と続いた．同時性胃癌19例のうち6例で胃癌の治療が先行され，13例でCRTが先行された．5例に無病生存が得られたが，8例が食道癌死で死亡例の57％を占めた．同時性頭頸部癌11例は頭頸部に進行例が多かったため9例で頭頸部癌手術が先行された．食道・頭頸部癌両方とも治癒したのは3例のみで，5例が食道癌死，3例が頭頸部癌死であった．CRT後subsequent tumorの発生は，CRT後CR例の蓄積と長期的観察による検討が必要であろう．食道癌に対するCRTが普及してきた現在、重複癌合併食道癌に対するCRTは，食道癌の根治性を考慮した治療戦略が重要であると考えられた．

　We reviewed our clinical experiences of chemoradiotherapy (CRT) for esophageal cancer (EC) in 44 patients with multiple primary malignant neoplasms. Among them, 34 were accompanied with synchronous tumors, 8 were accompanied with antecedent tumors and 8 with subsequent tumors. The sites of primary malignant neoplasms were as follows ; stomach 24 (43.6％), head and neck 17 (30.9％), colon and rectum 4 (7.3％). Among the 19 patients with synchronous cancer in the stomach, 6 patients underwent gastrectomy or endoscopic mucosal resection before CRT, and the others received definitive CRT as initial treatment. While 5 patients were alive without recurrence of EC and gastric cancer, more than half of the patients died of EC. Among 11 patients with head and neck cancer (HNC), 9 patients underwent surgery for HNC before CRT, because the clinical stages of the HNC was more progressive than that of EC. Only 3 patients achieved complete cure of both EC and HNC. The number of patients who developed subsequent tumors after CRT for EC was too small for us to draw definitive conclusions from our discussion, so further long-term follow-up and analysis based on large-scale surveys are required. Although CRT has become one of the standard treatments for EC, there is no treatment strategy for patients with both EC and other malignant primary neoplasms. Our results suggest that we should consider the curability of EC by CRT when we treat such patients.