m3食道表在癌に対する内視鏡的切除後の追加化学放射線療法から10年後に放射線性胸膜炎により死亡した1例

A Patient Who Died of Radiation Pleuritis 10-years after Additional Chemoradiotherapy of Endoscopic Resection for m3 Superficial Esophageal Cancer, Report of a Case

要旨　症例は61歳の女性．人間ドックの上部内視鏡検査にて食道病変が発見された．0-IIc型食道癌，深達度m_1～2と診断し，内視鏡的粘膜切除術を施行した．病理組織診断はSCC，m₃（浸潤幅2,800μm），ly0，v0，0-IIc，Mt，Post，25×15mmであった．追加治療として化学放射線療法（FP療法＋40Gy）を施行し，その後再発は認めなかった．追加治療から8年後に労作時呼吸困難と難治性胸水が出現し，放射線療法の晩期毒性による放射線性胸膜炎と診断した．対症的に胸水ドレナージを繰り返し施行したが，次第に呼吸不全が進行し，呼吸器症状出現から1年11か月後に死亡した．

　A 61-year-old woman was admitted to our hospital because of superficial esophageal cancer, 0-IIc. EMR was performed and the pathological diagnosis was SCC, m₃ (width 2,800μm), ly0, v0, Infα, Mt, Post, 25×15mm. Additional chemoradiotherapy (FP＋40Gy) was performed and there had been no recurrence. 8 years after this additional therapy, dyspnea on effort and pleural effusion appeared. There was no evidence of malignant or infectious diseases, so she was diagnosed as radiation pleuritis caused by the late toxicity of radiation therapy. Although pleural effusion drainage was performed, she died of advanced respiratory failure 23 months after the appearance of respiratory symptoms. A new radiation protocol containing an adequate radiation field and dose should be established to avoid the late toxicity of radiation therapy.