食道sm2/sm3癌に対する放射線・化学療法の治療成績―clinical stage Ⅰ食道癌に対する放射線・化学療法について

Chemoradiotherapy for Superficial (sm2/sm3) Esophageal Cancer-Chemoradiotherapy for Clinical Stage Ⅰ Esophageal Cancer

要旨　sm2/sm3癌を代表とする，EMR適応外のcStageⅠ食道癌71症例の放射線・化学療法の治療成績をまとめた．治療は，抗癌剤（5FU700mg/m²/日，4日間の持続静注とCDDP70mg/m²/日，第1日目に点滴静注）と放射線1日2Gy，3週間15回の30Gy照射を計2コース（照射総量60Gy）行った．CRは66例（93％）に認められた．有害事象は全体に軽度であったが，機能障害を来さない程度の晩期毒性が比較的高頻度に認められた．全71例の1，2，3年生存率はそれぞれ97％，90％，80％であり，外科的切除術に匹敵する生存成績であった．放射線・化学療法は有望であり，現時点において選択肢の1つとして挙げるべき治療法である．

　We studied the clinical outcome of chemoradiotherapy for clinical Stage Ⅰ squamous cell carcinoma of the esophagus. Seventy-one patients without possibility of cure by endoscopic mucosal resection (EMR) were analyzed. Patients received continuous infusion of 5FU at a dose of 700 mg/m²/24 hours on days 1 to 4, combined with CDDP at a dose of 70 mg/m² on day 1, and concurrent radiation therapy at a dose of 30 Gy in 15 fractions over 3 weeks. This schedule was repeated twice every 4 weeks, for a total radiation dose of 60 Gy. The 66 patients (93%) achieved a complete response. Toxicities were generally mild, but late radiation morbidity was relatively frequent. However, no toxicities interfering with function were seen. With a median follow-up duration of 23 months, the 1, 2 and 3-year survival rates were 97%, 90% and 80%, respectively. This survival rate compared with that obtained by ordinary surgery with three-field lymph node dissection. Chemoradiotherapy for clinical Stage Ⅰ esophageal cancer is a promising method, because of its safety and its being a curative therapy. We should present this therapy as well as surgery as an option of possibly curative therapy to patients with clinical Stage Ⅰ esophageal cancer.