内容紹介
Summary
A 24-year-old man with acute lymphoblastic leukemia underwent allogeneic peripheral blood stem cell transplantation(allo-PBSCT)from a human leukocyte antigen-matched sibling after myeloablative conditioning, with a regimen including total body irradiation(TBI)(12 Gy/6 fractions), 6 years ago. The patient developed extensive chronic graft-versus-host disease(cGVHD)of the skin, mouth, liver, and gut four months after allo-PBSCT. Treatment with cyclosporine and prednisolone was necessary to control the cGVHD. Six years after allo-PBSCT, the patient experienced odynophagia and was diagnosed with cervical esophageal squamous cell carcinoma(cT1bN1M0, cStageⅡB). Because we considered laryngeal preservation, risk of anastomotic leakage, and infection related to the operation, the patient was planned to receive chemoradiotherapy with 5-fluorouracil and cisplatin. Regarding irradiation, the patient received radiotherapy(50.4 Gy/28 fractions)for a primary tumor and lymph node without an elective nodal area. The patient achieved complete response and remained disease-free without any treatment-related complications for 3 years.
要旨
症例は24歳,男性。18歳時に急性リンパ性白血病に対し同種末梢血幹細胞移植を行い,移植4か月後から慢性移植片対宿主病に対して免疫抑制剤を継続内服中であった。移植6年後に嚥下時痛の増悪を契機に頸部食道癌(cT1bN1M0,cStageⅡB)と診断された。免疫抑制剤の長期内服から手術による縫合不全や感染症のリスクが高いことと,喉頭温存の面から化学放射線療法の方針となった。全身照射(12 Gy/6回)の既往があることから照射野と照射線量を考慮し,予防照射を省略した5-fluorouracil/cisplatin併用の照射(50.4 Gy/28回)を行った。原発巣,リンパ節転移は消失し,治療3年後も有害事象なく無再発生存中である。
目次
A 24-year-old man with acute lymphoblastic leukemia underwent allogeneic peripheral blood stem cell transplantation(allo-PBSCT)from a human leukocyte antigen-matched sibling after myeloablative conditioning, with a regimen including total body irradiation(TBI)(12 Gy/6 fractions), 6 years ago. The patient developed extensive chronic graft-versus-host disease(cGVHD)of the skin, mouth, liver, and gut four months after allo-PBSCT. Treatment with cyclosporine and prednisolone was necessary to control the cGVHD. Six years after allo-PBSCT, the patient experienced odynophagia and was diagnosed with cervical esophageal squamous cell carcinoma(cT1bN1M0, cStageⅡB). Because we considered laryngeal preservation, risk of anastomotic leakage, and infection related to the operation, the patient was planned to receive chemoradiotherapy with 5-fluorouracil and cisplatin. Regarding irradiation, the patient received radiotherapy(50.4 Gy/28 fractions)for a primary tumor and lymph node without an elective nodal area. The patient achieved complete response and remained disease-free without any treatment-related complications for 3 years.
要旨
症例は24歳,男性。18歳時に急性リンパ性白血病に対し同種末梢血幹細胞移植を行い,移植4か月後から慢性移植片対宿主病に対して免疫抑制剤を継続内服中であった。移植6年後に嚥下時痛の増悪を契機に頸部食道癌(cT1bN1M0,cStageⅡB)と診断された。免疫抑制剤の長期内服から手術による縫合不全や感染症のリスクが高いことと,喉頭温存の面から化学放射線療法の方針となった。全身照射(12 Gy/6回)の既往があることから照射野と照射線量を考慮し,予防照射を省略した5-fluorouracil/cisplatin併用の照射(50.4 Gy/28回)を行った。原発巣,リンパ節転移は消失し,治療3年後も有害事象なく無再発生存中である。