取扱い規約における消化管癌に対する化学・放射線療法の原発巣評価

Evaluation of the Response of Primary Lesions to Chemotherapy and Radiotherapy According to the Japanese General Rules for Studies of Digestive Tract Carcinomas

要旨　2009年にRECISTガイドラインの改訂版であるversion 1.1が発表され，実臨床に沿った実用的な評価方法に変更されており，単純化がなされている．一方で，改訂版RECISTには消化管癌原発巣の評価に関する記載はなく，転移巣のみで評価が行われることになっているため，消化管癌原発巣はRECIST評価ではnon-target lesionの扱いになる．本邦では従来から各種消化管癌取扱い規約に基づき原発巣の評価を行っており，これまでに原発巣を評価しないことで生じる弊害についても多数報告されている．本稿では各種消化管癌取扱い規約による原発巣評価法の概説と原発巣評価の意義に関して述べる．

　The revised RECIST guidelines, version 1.1, were published in 2009, and evaluation methods were simplified and made more practical. However, primary lesions of digestive tract carcinomas are considered non-target lesions by the RECIST guidelines because version 1.1 is designed to evaluate only measurable metastatic lesions and does not mention primary lesions. In Japan, however, primary lesions have been conventionally evaluated according to guidelines of the Japanese rules for studies on each type of digestive tract carcinoma. Many studies have reported problems associated with not evaluating primary lesions. We describe general guidelines for the evaluation of primary lesions according to the guidelines of the Japanese rules for each type of digestive tract carcinoma and discuss the clinical significance of evaluating primary lesions.