内容紹介
Long-Term Complete Response in Postoperative Multiple Lung and Mediastinal Lymph Node Metastases of Esophageal Cancer Using Systemic Chemotherapy with DCF Treatment―A Case Report
Summary
A 59-year-old man was diagnosed with advanced thoracic esophageal cancer. He underwent neoadjuvant chemotherapy with cisplatin(CDDP), 5-fluorouracil(5-FU)(CF)followed by transthoracic esophagectomy with three-field lymphadenectomy. Histopathological examination revealed that the tumor was poorly differentiated squamous cell carcinoma invading the adventitia with 6 regional lymph node metastases. Four months after surgery, follow-up thoracic computed tomography(CT)showed multiple lung and mediastinal lymph node metastases. The patient's general condition was favorable, and he underwent systemic chemotherapy with docetaxel, CDDP, 5-FU(DCF). After 2 courses of DCF, chest CT revealed that the lung and mediastinal lymph node metastases had markedly decreased in size to the point of being unmeasurable. After receiving additional chemotherapy consisting of 2 courses of DCF and 8 courses of monthly docetaxel, the patient has been followed up without treatment. No tumor re-recurrence has occurred in the 6 years and 8 months since the first recurrence. In cases of recurrent or unresectable esophageal cancer, the rate of clinical response is reported to be higher for DCF than for CF. DCF is a tolerable regimen, even for postoperative patients, provided that monitoring is conducted for severe adverse events. In patients whose general conditions are favorable, DCF should be considered as a treatment option for recurrent esophageal cancer.
要旨 食道癌術後多発肺転移と縦隔リンパ節転移再発に対し,docetaxel/cisplatin(CDDP)/5-fluorouracil(5-FU)(DCF)療法を含む全身化学療法を行い,長期完全奏効が得られた1例を報告する。症例は59歳,男性。進行胸部食道癌に対して術前CDDP/5-FU(CF)療法を2コース施行した後,右開胸食道切除,3領域リンパ節郭清,胃管再建術を行った。病理所見は低分化型扁平上皮癌で,深達度はT3(外膜),縦隔内に6個のリンパ節転移を認めた。術後4か月目のCT検査で多発肺転移と縦隔リンパ節転移を認めた。全身状態が良好であったためDCF療法を施行したところ,2コース後の画像検査で肺転移,リンパ節転移ともに測定不能な大きさに縮小した。さらにDCF療法2コースとdocetaxel単剤療法8コースを施行し,以後は無治療で経過観察しているが,再発から6年8か月経過した現在まで無増悪生存中である。進行再発食道癌に対して,DCF療法はCF療法に比べて奏効率が高いとの報告がある。DCF療法は有害事象の予防や対処を適切に行うことで,再発食道癌に対する治療選択肢の一つとなり得る。
目次
Summary
A 59-year-old man was diagnosed with advanced thoracic esophageal cancer. He underwent neoadjuvant chemotherapy with cisplatin(CDDP), 5-fluorouracil(5-FU)(CF)followed by transthoracic esophagectomy with three-field lymphadenectomy. Histopathological examination revealed that the tumor was poorly differentiated squamous cell carcinoma invading the adventitia with 6 regional lymph node metastases. Four months after surgery, follow-up thoracic computed tomography(CT)showed multiple lung and mediastinal lymph node metastases. The patient's general condition was favorable, and he underwent systemic chemotherapy with docetaxel, CDDP, 5-FU(DCF). After 2 courses of DCF, chest CT revealed that the lung and mediastinal lymph node metastases had markedly decreased in size to the point of being unmeasurable. After receiving additional chemotherapy consisting of 2 courses of DCF and 8 courses of monthly docetaxel, the patient has been followed up without treatment. No tumor re-recurrence has occurred in the 6 years and 8 months since the first recurrence. In cases of recurrent or unresectable esophageal cancer, the rate of clinical response is reported to be higher for DCF than for CF. DCF is a tolerable regimen, even for postoperative patients, provided that monitoring is conducted for severe adverse events. In patients whose general conditions are favorable, DCF should be considered as a treatment option for recurrent esophageal cancer.
要旨 食道癌術後多発肺転移と縦隔リンパ節転移再発に対し,docetaxel/cisplatin(CDDP)/5-fluorouracil(5-FU)(DCF)療法を含む全身化学療法を行い,長期完全奏効が得られた1例を報告する。症例は59歳,男性。進行胸部食道癌に対して術前CDDP/5-FU(CF)療法を2コース施行した後,右開胸食道切除,3領域リンパ節郭清,胃管再建術を行った。病理所見は低分化型扁平上皮癌で,深達度はT3(外膜),縦隔内に6個のリンパ節転移を認めた。術後4か月目のCT検査で多発肺転移と縦隔リンパ節転移を認めた。全身状態が良好であったためDCF療法を施行したところ,2コース後の画像検査で肺転移,リンパ節転移ともに測定不能な大きさに縮小した。さらにDCF療法2コースとdocetaxel単剤療法8コースを施行し,以後は無治療で経過観察しているが,再発から6年8か月経過した現在まで無増悪生存中である。進行再発食道癌に対して,DCF療法はCF療法に比べて奏効率が高いとの報告がある。DCF療法は有害事象の予防や対処を適切に行うことで,再発食道癌に対する治療選択肢の一つとなり得る。