原発性肺癌術後再発例に対する集学的治療

Multidisciplinary Approach to Recurrence after Resection of Primary Lung Cancer

術後局所再発や少数遠隔転移に対して外科治療1,2）あるいは放射線治療3）などにより，良好な予後を示す報告がなされてきた．一方，複数転移を認める病理病期Ⅳ期に準ずる進行型非小細胞肺癌に対して，いかなるプラチナ製剤＋新規抗癌薬を使用しても8～14ヵ月程度の生存期間中央値であった4～6）．しかし，近年薬物療法の進歩などもあり，集学的治療による戦略が確立されてきた7,8）．筆者らは，原発性肺癌の術後再発例

Background：The standard approach for treating recurrence after complete resection of primary non-small cell lung cancer has been controversial. We present here a multidisciplinary strategy for postoperative recurrence in patients with primary lung cancer．

Patients and Methods：Over the last 7 years, we examined the disease-free survival and overall survival of 70 patients who underwent multidisciplinary treatment for recurrence after surgical resection of primary lung cancer．

Results：The median overall survival was 32.3 months after surgery and 17.4 months after recurrence developed, indicating significantly better prognoses in females and in patients with adenocarcinoma, stage I disease, driver mutation positivity, a longer postoperative disease-free period, and never smokers. Eight patients survived more than 5 years after recurrence；of these patients, all had adenocarcinomas, 7 had oligometastases and/or tumor dormancy, and 5 received multiple-drug regimens．

Conclusion：Multidisciplinary treatment for recurrence after resection of primary lung cancer was effective for patients receiving various drug regimens. In patients with oligometastases, disease control was achieved by a combination of local treatments targeting each involved organ. In patients with tumor dormancy, follow-up or a drug holiday was important to maintain the patient’s quality of life．