内視鏡的立場からみた放射線照射による胃癌の肉眼的変化

Endoscopic Changes by Supervoltage Radiation Therapy for Stomach Cancer

　癌の治療法としては，外科的療法，放射線療法，化学療法，ホルモン療法などがあげられるが，胃癌に関しては，早期のものは外科的療法，末期のものは化学療法を行なうのが普通で放射線療法は必ずしも広く行なわれているとは言えない．

　胃癌を放射線照射療法により治癒せしめようとする試みは古く1886年Despeignesの報告があり，わが国では1928年山川が初めて胃癌の放射線照射療法を行なって以来，幾つかの報告がみられるが，他の分野に比べてその数は甚だ少ない．

　Thirty two patients with stomach cancer were treated by supervoltage radiation therapy during about four years at the Miyagi Prefectural Center for Adult Diseases. The results had been already discussed both histologically and cytologically in our previous reports accompanied with the end-results. In 26 cases of gastric cancer with a marked protrusion at least in a part of the lesion (2 cases of Borrmann Type Ⅰ, 14 of Type Ⅱ and 10 of Type Ⅲ), the most noticiable change in all was that the protrusion became gradually flat, and in most cases the area of ulcer became enlarged due to ulceration of the protruded part, with margins of the ulcer becoming more flat and distinct.

　In another 6 cases of depressed type without any marked protrusion (Borrmann Type Ⅳ in 2 cases and Ⅱc type early cancer in 4), ulcer became shallow and shrank because ulcer margins became indistinct, so that the lesion itself in some cases looked as if it had shrunk.

　In both of the groups no enlargement of cancer lesion was found.

　In the observation of the relationship between endoscopic changes and irradiation dose, some of the above-mentioned changes were significantly found in most of the cases irradiated with more than 5,000 rads. Sometimes, we observed a distinct change already in cases irradiated with smaller doses even of 2,000 rads.

　In our series not a case was observed in which the size of the cancer lesion had enlarged in the course of irradiation. Endoscopic changes by supervoltage radiation therapy for stomach cancer is considered greater in the protruded part than in the others.