食道SM癌への光線力学療法（PDT）

Photodynamic Therapy for T1b Esophageal Cancer

要旨●光線力学療法（PDT）は，食道癌化学放射線療法（CRT）後の局所遺残再発病変に対するサルベージ内視鏡治療である．局所遺残再発症例に対する一般的な治療は外科手術であるが，侵襲が大きい点が課題である．一方，PDTは低侵襲であり，手術不耐，拒否症例でも根治を目指せる治療である．従来のフォトフリン^®PDTと比べ，レザフィリン^®PDTは利便性が向上し，より安全で有効な治療となった．CRT後には適切に定期的な内視鏡を行い，早期に局所遺残再発病変を診断することで，サルベージ内視鏡治療の機会を逸しないことが重要である．サルベージ内視鏡治療後の効果予測因子についても知見が得られつつあり，治療の選択基準確立の一助となることが望まれる．

　PDT（photodynamic therapy）is an endoscopic salvage treatment used for local failure after CRT（chemoradiotherapy）for esophageal cancer. Salvage esophagectomy is generally indicated for patients with local failure after CRT ; however, it is associated with a high rate of postoperative complications and mortality. PDT is a minimally invasive salvage treatment that can be radically effective even for patients considered inoperable due to physical intolerance or refusal to consent to surgery. PDT with talaporfin sodium, approved for use in 2015, is much more convenient and produces more favorable short-term outcomes, including local control and safety, compared to PDT with porfimer sodium. Earlier detection of local failure with post-CRT endoscopy at appropriate intervals enables patients to receive minimally invasive salvage endoscopic treatment. Some reports have identified factors that predict the therapeutic efficacy of endoscopic salvage treatment and can be used to inform the selection of an endoscopic treatment strategy against local failure after CRT.