腎癌術後の60Co照射による胃潰瘍の1例

A Case of Gastric Ulcer Induced by 60Co-Irradiation after Nephrectomy for Renal Tumor

　悪性腫瘍に対する放射線治療は，各種抗癌剤が普及している現今でも不可欠の治療法である．その方法は高圧装置の開発とともに治療面ですぐれた効果をおさめているが，反面副作用もまたまぬがれない．

　放射線照射による消化管障害は，1897年Walsh¹⁾によって報告されて以来，消化管粘膜にたいする放射線障害が論じられている．一般に消化管の放射線障害は子宮癌，精巣癌などにおける放射線治療の際，隣接する直腸，膀胱粘膜への影響にかんして多くの論文がみられるが，胃粘膜障害についての報告は少ない．

　A 28-year-old housewife had undergone total nephrectomy for left renal tumor on December 16, 1975. After operation till January 28, 1976, she had taken a total of 5,750R (250R×23) ⁶⁰Co-irradiation and progesteron administration. Since the middle of January 1976, anorexia, hypochondralgia, right-hand back pain, nausea and vomiting appeared and she visited this hospital on February 18, 1977.

　Endoscopic examination revealed reddened, edematous and erosive mucosal folds on the upper and middle paxt of the body extending from the greater curvature to the posterior wall 20 days after the final radiation, and a type-Ⅱc-like ulceration accompanying islets with irregularly defined margin on the anterior wall of the upper body, suggesting further development of the previous lesion another two months later. On the fifth month, the ulcer on the anterior wall of the upper body was found disappeared, whereas there was a newly formed ulceration with ill-defined margin, extending from the lesser curvature to the posterior wall of the lower body which keeps scarring alone at the present time. Specimens from five biopsies performed during the period showed cells with enlarged nucleus-cell body ratio and atypical cells, but none of malignant alterations in the tissue. It was obvious that this patient's change belonged to Friedmans type Ⅲ to Ⅳ where medical treatment was reported to be less curable, and so invasive therapeutic procedures were recommended, although this patient showed satisfactory healing after the treatment solely consisted of medical therapeutic course which, we considered, the patient's general conditions and the topical findings indicated.

　We presumed that one of the possible causes for the production of the post-irradiation ulcers was due to inadvertent overdosing of the ⁶⁰Co radiation above critical level as many reports suggested correctly.