食道扁平上皮癌ESD瘢痕の近傍再発でESD困難のためPDTを施行した1例

Photodynamic Therapy for Local Recurrence near Endoscopic Submucosal Dissection Scar for Esophageal Squamous Cell Carcinoma Due to ESD Difficulty, Report of a Case

要旨●患者は60歳代（後半），男性．5年前に胸部下部〜腹部食道の粘膜下層浸潤を疑う食道扁平上皮癌に対して陽子線単独照射療法が行われた．その後，胸部下部食道後壁に0-IIc型病変の再発を認め，内視鏡的切除適応と考え内視鏡的粘膜下層剝離術（ESD）を施行した．その8か月後，胸部下部〜腹部食道にESD瘢痕にかかる0-IIc型病変を認めた．ESD困難のため光線力学的療法（PDT）を施行し，寛解が得られた．しかし2年4か月後，PDT瘢痕口側のESD瘢痕内に0-IIb型病変の再発を認め，再PDTを施行した．寛解が得られ，1年半無再発である．

　A man in his 60s was treated with proton irradiation alone 5 years ago for esophageal squamous cell carcinoma, which was located in the lower thoracic to abdominal esophagus and was suspected of submucosal invasion. A recurrent type 0-IIc lesion was detected on the lower thoracic esophagus posterior wall and was treated with ESD（endoscopic submucosal dissection）. A type 0-IIc lesion was detected 8 months later in the lower thoracic to abdominal esophagus, which overlapped the ESD scar. PDT（photodynamic therapy）was performed for the recurrent lesion due to ESD difficulty and a complete response was achieved. A recurrent type 0-IIb lesion was detected 2 years and 4 months later within the ESD scar and at the oral side of the PDT scar. PDT was again performed for the recurrent lesion. The patient achieved a complete response and has been relapse-free for 1.5 years.