胸壁浸潤肺癌に対する集学的治療

Multimodality Therapy for Lung Cancer with Chest Wall Invasion

胸壁浸潤肺癌に対する外科切除の成績が2000年前後に相次いで報告されたが，その5年生存率はリンパ節転移を認めない症例群でもおおよそ40％台であった1～3）．2010年に集積された肺癌登録合同委員会による全国調査からの解析でも，胸壁浸潤肺癌T3N0M0切除例の5年生存率は49％とあまり改善はみられなかった4）．また局所進行肺癌に対する標準治療は手術と術後補助療法とされているが，全国調査によると33％

The standard therapy for patients with T3N0-1M0 non-small cell lung cancer （NSCLC） involving the chest wall is considered initial resection and adjuvant chemotherapy. However, the compliance of adjuvant therapy is relatively low, and the prognosis for those patients has not been satisfactory. We therefore advocated a new strategy of induction chemoradiotherapy followed by surgery and conducted a prospective, multi-institutional phaseⅡ trial with the aim of improving the survival. The mature results of this trial showed the treatment strategy to be safe and effective with a high rate of pathologic response.

We also reviewed surgical cases in our hospital retrospectively. Induction therapy was administered for a half of patients with NSCLC involving the chest wall, and a pathologic complete response （Ef.3） was obtained in 23％ of those cases with an excellent prognosis. We therefore conclude that induction therapy, especially chemoradiotherapy, would increase the possibility of cure for NSCLC patients with chest wall invasion.