根治的化学療法後にサルベージ手術を施行したN3非小細胞肺癌

Salvage Surgery after Radical Chemotherapy for N3 Non-small Cell Lung Cancer

非小細胞肺癌に対するサルベージ手術の意義は明らかでない．われわれは手術適応のないN3局所進行肺腺癌に対し，根治的化学療法後に残存主病変の切除を行い，8年以上の無再発生存となっている1例を経験したので報告する．

A 49-year-old man was admitted to our hospital for an abnormal chest shadow. Computed tomography showed a pulmonary nodular shadow in the right upper lobe and swelling of the right hilar, mediastinal and supraclavicular lymph nodes. A positron emission tomography（PET） scan showed fluorodeoxyglucose accumulation in the tumor and swollen lymph nodes. He was diagnosed with stage cT1aN3M0（ⅢB） pulmonary adenocarcinoma and was treated with a combination of cisplatin and paclitaxel. After 6 cycles of chemotherapy, serum carcinoembryonic antigen （CEA） level was markedly decreased. A PET scan showed fluorodeoxyglucose accumulation only in the primary site. He was diagnosed with stage ycT1aN0M0（ⅠA） disease, and the salvage surgery was scheduled. As chemotherapy had resulted in severe fibrosis of the lung hilum, he underwent a partial resection. After partial resection of the right upper lobe, he has been alive without recurrence for 8 years.