化学放射線治療により長期生存した原発不明肺門縦隔リンパ節扁平上皮癌の1例

A case of long-term survival with hilar and mediastinal lymph node squamous cell carcinoma of unknown primary treated with concurrent chemoradiation

原発不明癌の組織型は，腺癌あるいは低分化癌のことが多く，扁平上皮癌の頻度は少ない^1）。原発不明扁平上皮癌のほとんどは，頸部・鎖骨上窩リンパ節あるいは鼠径部リンパ節腫大で発見され，肺門縦隔リンパ節腫大で発見される頻度も少ない^2）。今回我々は，原発不明肺門縦隔リンパ節扁平上皮癌に対して化学放射線治療を実施し，長期生存が得られた1例を経験したので文献的考察を加えて報告する。

A 60s male presented with a progressive swallowing disturbance and effort dyspnea. PET/CT demonstrated multiple tumors in the right neck, mediastinum and left hilar, compressing the esophagus and the left main bronchus. Right supraclavicular lymph-node biopsy was undertaken. Histological examination revealed squamous cell carcinoma. He was treated with IG-VMAT with concurrent chemotherapy. Two weeks after chemoradiation initiation, the tumors regressed markedly on CBCT. He received a total dose of 70 Gy irradiation. He had several relapse of lymph nodes, and was treated IG-VMAT a total dose of 66 Gy. He has been alive without the disease, and been engaged in the dentistry from the initial therapy which completed 68 months before.