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The Japanese Journal of Thoracic Surgery Volume 74, Issue 1 （January 2021）

胸部外科 74巻1号（2021年1月発行）

Japanese English

特集再発・同時異時多発肺癌に対する外科治療戦略とアウトカム

2. 異時多発

異時性多発肺癌に対する治療戦略 Therapeutic Strategies for Metachronous Multiple Primary Lung Cancer 臼田実男 ¹ , 松本充生 ¹ , 鈴木健人 ¹ , 富岡勇宇也 ¹ , 園川卓海 ¹ , 井上達哉 ¹ , 榎本豊 ¹ Jitsuo Usuda ¹ , Mitsuo Matsumoto ¹ , Kento Suzuki ¹ , Yuya Tomioka ¹ , Takumi Sonokawa ¹ , Tatsuya Inoue ¹ , Yutaka Enomoto ¹ ¹日本医科大学呼吸器外科 ¹Department of Thoracic Surgery, Nippon Medical School キーワード：多発肺癌 , 体幹部定位放射線療法（SBRT） , 肺葉切除 , 光線力学的治療（PDT） Keyword: multiple primary lung cancer , stereotactic body radiation therapy （SBRT） , lobectomy , photodynamic therapy （PDT） pp.18-21

発行日 2021年1月1日 Published Date 2021/1/1

DOI https://doi.org/10.15106/j_kyobu74_18

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参考文献 Reference

肺癌術後治療成績の向上や平均寿命の高齢化がすすみ，肺癌手術後の第2肺癌に遭遇することはまれではない．特に，すりガラス状陰影（GGO）を主体する予後良好な肺癌は，多発する傾向がみられる．異時性多発肺癌患者には高齢者が多く，肺癌手術の既往を有するケースも決してまれではない．高齢者は，さまざまな併存症を有し，低肺機能のため，標準治療である肺葉切除が困難なことも少なくない1，2）．超高齢化を迎えるわが国では，今後ますます多発肺癌症例が増加することが考えられ，さまざまな治療戦略を講じる必要がある．そのため，当施設で経験した異時性多発肺癌症例について臨床・病理学的に解析し，今後の治療戦略について検討した．

Backgrounds：It is not uncommon to encounter metachronous primary lung cancer after surgical treatment along with the increase in the elderly patients. In consideration of increasing number of such patients, it is necessary to take various treatment strategies.

Methods：In order to establish a treatment strategy for multiple lung cancer, we retrospectively examined multiple lung cancer cases operated for primary lung cancer in our department from January 2013 to December 2019, and the future treatment strategy was examined.

Results：Of 821 patients who underwent surgery for primary lung cancer, 61 were multiple lung cancers, 31 were synchronous multiple lung cancers, and 30 were metachronous multiple lung cancers. Among the cases of metachronous multiple lung cancer, 28 cases had undergone lobectomy or more in the first operation, 1 case of segmental resection, and 1 case of partial resection. As for the treatment of secondary lung cancer lesions, 21 lesions were performed surgery （lobectomy；2, segmental resection；2, partial resection；17）, 6 lesions of photodynamic therapy （PDT）, and 3 lesions of stereotactic body radiation therapy （SBRT）. Among the surgical cases, there were three cases on the same side as the first cancer and 18 cases on the opposite side. The three cases underwent partial resection. Among 21 patients, postoperative home oxygen therapy was introduced in 2 patients. Regarding the prognosis, three patients who had surgical resection, died of recurrence of the first lesion. One of the six PDT patients died of recurrence of the first lung cancer and another died of other disease. All three patients who underwent SBRT are alive without recurrence.

Conclusions：If early detection and early diagnosis are made as a treatment strategy for metachronous multiple lung cancer, it may be possible to preserve lung function by reducing surgery or SBRT, PDT, and to cure without damaging the quality of life.