内容紹介
Summary
A 70s man was admitted to our hospital complaining of chest discomfort. Endoscopic examination showed mucosal erythema and irregularity and an area unstained by iodine in the middle esophagus 21 to 41 cm from the incisors. The biopsy specimen showed moderately differentiated squamous cell carcinoma. An abdominal computed tomographic(CT)scan revealed swelling of the lymph nodes along the celiac artery and abdominal aorta. The patient was diagnosed with unresectable advanced esophageal cancer(cT2N4M0, cStage Ⅳa). Systemic chemotherapy was initiated using a regimen of 5-FU and cisplatin(FP). After 2 courses of chemotherapy, an abdominal CT scan showed reduction of the lymph node swelling along the abdominal aorta, but the lymph node swelling remained along the celiac artery. Therefore, chemoradiotherapy(CRT; FP plus RT 60 Gy/30 Fr at the main tumor and the swelling of lymph nodes along the celiac artery)was administered. An abdominal CT scan showed reduced swelling of the lymph nodes along the abdominal aorta and the celiac artery after CRT. In addition, FP chemotherapy was also administered. A PET-CT scan showed no increased FDG up take in the main tumor and swollen lymph nodes after 2 courses of chemotherapy. The complete response(CR)has been maintained for 30 months without therapy.
要旨
症例は70歳台,男性。上部消化管内視鏡検査にて切歯21 cmから41 cmにかけて粘膜の発赤と不整を認め,ヨード染色にて全周性に不染帯を認めた。切歯35 cmの食道右壁で一部凹凸を認め,深達度はMPと診断した。胸腹部造影CTにて一塊となったNo. 9リンパ節の腫大と,No. 16リンパ節の腫大を認めた。以上より,進行食道癌,cT2N4M0,cStage Ⅳaと診断し,5-FU+CDDP(FP)療法を実施する方針とした。2コース実施したところ,上部消化管内視鏡検査にて粘膜の発赤や不整は消失した。No. 16リンパ節は縮小したがNo. 9リンパ節は縮小するも残存していたため,追加で化学放射線療法を行う方針とした。主病変とNo. 9リンパ節にそれぞれ60 Gy/30 Frずつ照射し,FP療法を2コース実施した。終了後の胸腹部CTではPRを得られたため,さらにFP療法を2コース実施した。その後のPET-CTで原発巣やNo. 9リンパ節・No. 16リンパ節に異常集積を認めず,CRを得られた。現在,30か月無治療でCR継続中である。
目次
A 70s man was admitted to our hospital complaining of chest discomfort. Endoscopic examination showed mucosal erythema and irregularity and an area unstained by iodine in the middle esophagus 21 to 41 cm from the incisors. The biopsy specimen showed moderately differentiated squamous cell carcinoma. An abdominal computed tomographic(CT)scan revealed swelling of the lymph nodes along the celiac artery and abdominal aorta. The patient was diagnosed with unresectable advanced esophageal cancer(cT2N4M0, cStage Ⅳa). Systemic chemotherapy was initiated using a regimen of 5-FU and cisplatin(FP). After 2 courses of chemotherapy, an abdominal CT scan showed reduction of the lymph node swelling along the abdominal aorta, but the lymph node swelling remained along the celiac artery. Therefore, chemoradiotherapy(CRT; FP plus RT 60 Gy/30 Fr at the main tumor and the swelling of lymph nodes along the celiac artery)was administered. An abdominal CT scan showed reduced swelling of the lymph nodes along the abdominal aorta and the celiac artery after CRT. In addition, FP chemotherapy was also administered. A PET-CT scan showed no increased FDG up take in the main tumor and swollen lymph nodes after 2 courses of chemotherapy. The complete response(CR)has been maintained for 30 months without therapy.
要旨
症例は70歳台,男性。上部消化管内視鏡検査にて切歯21 cmから41 cmにかけて粘膜の発赤と不整を認め,ヨード染色にて全周性に不染帯を認めた。切歯35 cmの食道右壁で一部凹凸を認め,深達度はMPと診断した。胸腹部造影CTにて一塊となったNo. 9リンパ節の腫大と,No. 16リンパ節の腫大を認めた。以上より,進行食道癌,cT2N4M0,cStage Ⅳaと診断し,5-FU+CDDP(FP)療法を実施する方針とした。2コース実施したところ,上部消化管内視鏡検査にて粘膜の発赤や不整は消失した。No. 16リンパ節は縮小したがNo. 9リンパ節は縮小するも残存していたため,追加で化学放射線療法を行う方針とした。主病変とNo. 9リンパ節にそれぞれ60 Gy/30 Frずつ照射し,FP療法を2コース実施した。終了後の胸腹部CTではPRを得られたため,さらにFP療法を2コース実施した。その後のPET-CTで原発巣やNo. 9リンパ節・No. 16リンパ節に異常集積を認めず,CRを得られた。現在,30か月無治療でCR継続中である。