放射線・化学療法にて著効，5年生存中の0-Ⅱc型食道粘膜下層癌（sm3）の1例

A Type 0-Ⅱc Squamous Cell Esophageal Carcinoma with Massive Submucosal Invasion which Showed Complete Reaction to Chemoradiotherapy and Survived more than Five Years, Report of a Case

要旨　症例は71歳，女性．1997年1月人問ドックの内視鏡検査にて食道癌を指摘．内視鏡検査では切歯列より28～34cmに1/2周性の0-Ⅱc病変あり．隆起成分が広範に認められ，深達度sm3と診断．病変口側には壁内転移も認め，生検では低分化～中分化型扁平上皮癌であった．食道造影検査では，胸部中～下部食道に長径約6cm，1/2周性の0-Ⅱc病変あり．陥凹内に粗大顆粒状隆起があり，同部の壁に硬化所見を認め，深達度sm3以上と診断．頸部超音波検査にて，左鎖骨上窩にリンパ節転移が疑われた．①壁内転移を有する0-Ⅱc型食道癌で，深達度sm3以深，②組織学的には低分化～中分化型扁平上皮癌，③頸部リンパ節転移が疑われる病変，以上の点から放射線・化学療法を選択．放射線はlong-Tで70Gy照射，しかし，化学療法はCDDP15mgにて白血球低下のため中止．治療終了時には，病巣は平坦化していた，治療後5年経過した現在，再発なく健在である．

　A 71-year-old woman was admitted to our hospital because of mild dysphagia. She had enjoyed good health until a gastric polyp was noted during an annual examination. She underwent a upper gastrointestinal endoscopy and a lesion in the middle and lower third of the esophagus was suspected to be a carcinoma. She was referred to our hospital for further examination and treatment. The esophageal lesion was estimated to be a type 0-IIc cancer as it had reddening and a slight depression which occupyed half the circumference of the esophagus. A massive cancer invasion into the submucosa was strongly suspected because it had many coarse granular components. Pathological studies on biopsy specimens from the lesion revealed a poorly differentiated squamous cell carcinoma. There were some small and elevated lesions covered by normal esophageal mucosa close to the main lesion, which suggested intramural metastases of the esophageal cancer. An ultrasonography on the neck detected a lymph node swelling in the left supraclavicular region. These facts suggested a superficial esophageal cancer with poor prognosis and so, radiochemotherapy was indicated. Irradiation of the bilateral supraclavicular regions and the whole mediastinum, paracardia and the caeliac axis was carried out. Although simultaneous chemotherapy using a low dose of CDDP (5mg daily) was planned, after the administration of CDDP only three times, leucopenia (WBC=1,600/μl) developed and it was not improved by the administration of G-CSF. Consequently, irradiation was carried out without chemotherapy. The esophageal cancer had completely disappeared after irradiation of 70 Gys. Her clinical course was uneventful. The patient is doing well five years after the treatment without any sign of recurrence.