食道sm2/sm3癌に対して放射線化学療法を行い5年以上経過している1例

A Patient with sm2/sm3 Esophageal Cancer, Treated by Combined Radiotherapy and Chemotherapy, Who has so far Survived for Five Years, Report of a Case

要旨　リンパ節転移を伴う食道sm2/sm3癌に対して放射線化学療法が有効であった症例を経験したので報告する．患者は67歳，男性．食道Mtの0-Ⅰ＋Ⅱc（sm2/sm3）で101L，Rにリンパ節転移が認められた．患者はQOLを重視し手術を拒否したため放射線化学療法を選択した．頸部から主病巣下端までのT字照射66Gy，CDDP10mg/日×5日×4週（合計200mg）を行い，さらに10Gyの腔内照射を追加した．主病巣は潰瘍瘢痕となりCRと判定されたが，101R（17×10mm），L（10×5mm）のリンパ節はそれぞれ12×7mm，5×4mmに縮小したものの残存した．その後徐々に縮小し101Rは1年半で消失した．4年半後切歯より21cmに0-Ⅱc病変が認められ，EMRを施行した〔m1，VM(－)，LM(－)，ly₀，v₀〕．初療より5年経過し，現在再発の兆候なく生存中である．

　We reported that combined radiotherapy and chemotherapy was effective with a patient with sm2/sm3 esophageal cancer with lymphnode metastasis in the neck. A 67-year-old man was referred to our hospital for the treatment of esophageal cancer where the depth of the esophageal wall was diagnosed as sm2/sm3 by endoscopy and endoscopic ultrasonograpy (EUS). EUS showed still more lymphnode metastases in 101R and L. We recommended him to have an esophagectomy and lymphnode dissection which is the standard treatment for such type of esophageal cancer, but he refused the surgical treatment because he was afraid of the possible damage to the quality of his life after the surgery. So we decided to perform external radiotherapy including from the neck to the main tumor at 66 Gy and internal radiotherapy at 10 Gy, and chemotherapy at 10 mg/5 days/4 weeks of CDDP. The main tumor completely vanished with the ulcer scar remaining and the lymphnode metastases shrank from 17×10 mm (101L), 10×5 mm (101R) to 12×7 mm, 5×4 mm. One and half years, after radiochemotherapy, the lymphnode of 101R disappeared completely. Endoscopy showed 0-IIc esophageal cancer 21 cm from his teeth 4 and half years after the treatment. Endoscopic mucosal resection was performed on that lesion 〔m1, VM(-), LM(-), ly₀, v₀〕. There has been no evidence of recurrence for more than 5 years.