内容紹介
Summary
Background: Since the introduction of the guideline for the diagnosis and treatment of esophageal carcinoma in 2007, the indication for placing an esophageal stent has changed, especially with respect to the treatment of esophageal stricture after chemoradiotherapy(CRT). For CRT cases, irradiation after stent placement and stent placement after CRT are not recommended due to the risk of perforation. Methods: Thirty-eight patients who underwent esophageal stenting in our department between January 2007 and December 2018 and who were diagnosed with thoracic esophageal cancer were included in this study. We retrospectively examined the safety and treatment effect of esophageal stent placement. Results: Prior cancer therapy was observed in 16 cases(8 cases of chemotherapy and 8 cases of CRT). In the no prior therapy group, 13 cases were treated with BSC and 9 cases with chemotherapy. Esophageal stent placement after CRT was performed in 8 cases. Esophageal stent was placed 9(6-14)months after CRT. The stent patency period was 5(1-11)months, and the survival period after stent placement was 6(1-12)months. There was no difference in the frequency of complications and treatment outcomes of the CRT group compared with the non-CRT group. Conclusion: Cases undergoing esophageal stent placement after CRT can expect therapeutic effects similar to those of other cases. However, complications such as perforation can be fatal; thus, careful consideration should be given to each individual case for esophageal stent placement after CRT.
要旨
背景: 2007年に「食道癌診断・治療ガイドライン」の導入以降,食道ステントの適応が変化し,特に化学放射線療法(CRT)後の食道狭窄に対する治療が問題となることが多くなった。今回,ガイドライン導入後の緩和治療として食道ステント留置術を施行した症例について,その安全性や有効性について検討した。方法: 2007年1月～2018年12月までの間に当科で食道ステント留置術を施行した胸部食道癌38例を対象とした。結果: 前治療あり群の内訳は化学療法8例,CRTが8例であった。前治療なし群では,その後の治療としてbest supportive care(BSC)13例,化学療法が9例であった。CRT後の食道ステント留置は8例に施行し,CRT終了後より食道ステント留置までの期間(中央値)は9か月であった。結語: 緩和治療としての食道ステント留置は安全に施行でき,経口摂取再開には有用であった。CRT後の食道ステント留置は,その他の症例と同様の治療効果を期待できる。
目次
Background: Since the introduction of the guideline for the diagnosis and treatment of esophageal carcinoma in 2007, the indication for placing an esophageal stent has changed, especially with respect to the treatment of esophageal stricture after chemoradiotherapy(CRT). For CRT cases, irradiation after stent placement and stent placement after CRT are not recommended due to the risk of perforation. Methods: Thirty-eight patients who underwent esophageal stenting in our department between January 2007 and December 2018 and who were diagnosed with thoracic esophageal cancer were included in this study. We retrospectively examined the safety and treatment effect of esophageal stent placement. Results: Prior cancer therapy was observed in 16 cases(8 cases of chemotherapy and 8 cases of CRT). In the no prior therapy group, 13 cases were treated with BSC and 9 cases with chemotherapy. Esophageal stent placement after CRT was performed in 8 cases. Esophageal stent was placed 9(6-14)months after CRT. The stent patency period was 5(1-11)months, and the survival period after stent placement was 6(1-12)months. There was no difference in the frequency of complications and treatment outcomes of the CRT group compared with the non-CRT group. Conclusion: Cases undergoing esophageal stent placement after CRT can expect therapeutic effects similar to those of other cases. However, complications such as perforation can be fatal; thus, careful consideration should be given to each individual case for esophageal stent placement after CRT.
要旨
背景: 2007年に「食道癌診断・治療ガイドライン」の導入以降,食道ステントの適応が変化し,特に化学放射線療法(CRT)後の食道狭窄に対する治療が問題となることが多くなった。今回,ガイドライン導入後の緩和治療として食道ステント留置術を施行した症例について,その安全性や有効性について検討した。方法: 2007年1月～2018年12月までの間に当科で食道ステント留置術を施行した胸部食道癌38例を対象とした。結果: 前治療あり群の内訳は化学療法8例,CRTが8例であった。前治療なし群では,その後の治療としてbest supportive care(BSC)13例,化学療法が9例であった。CRT後の食道ステント留置は8例に施行し,CRT終了後より食道ステント留置までの期間(中央値)は9か月であった。結語: 緩和治療としての食道ステント留置は安全に施行でき,経口摂取再開には有用であった。CRT後の食道ステント留置は,その他の症例と同様の治療効果を期待できる。