内容紹介
Summary
Definitive chemoradiotherapy(CRT)for esophageal cancer is the standard treatment and alternative to surgery. However, the tolerability of CRT in elderly patients is not well known. In this study, we retrospectively analyzed 60 patients with esophageal cancer who were treated with CRT(5—FU 700 mg/m2, cisplatin 70 mg/m2, radiation 60 Gy)at our hospital between January 2015 and September 2017. The patients were divided into 2 groups:an elderly group comprising 16 patients aged >75 years and a non—elderly group comprising 44 patients aged <74 years. The relative dose intensity of cisplatin in the elderly group was significantly lower than that in the non—elderly group. Radiotherapy was successfully executed in both groups. More patients in the elderly(25%)than the non—elderly group(7%)developed pneumonitis, and all patients who developed severe pneumonitis in the elderly group died. Application of definitive CRT and irradiation methods in elderly patients with a subpleural reticular shadow should be carefully considered before initiating therapy.
要旨
食道癌の根治的化学放射線療法(CRT)は非外科的治療を行う場合の標準治療であるが,高齢者の忍容性は明らかではない。そこで2015年1月～2017年9月に当院で根治的CRT[5—FU 700 mg/m2,シスプラチン(CDDP)70 mg/m2,放射線60 Gy]を行った食道癌60例を,高齢者群(75歳以上)16例と非高齢者群(74歳以下)44例の2群で後方視的に比較検討を行った。CDDPの相対用量強度は高齢者群で有意に低かった。放射線治療完遂症例の割合は両群でほぼ同等であった。有害事象は重篤な肺臓炎の発症割合が高齢者群25%,非高齢者群7%と高齢者群で多い傾向で,高齢者群の重篤な肺臓炎症例は全例治療関連死に至った。特に,高齢者で胸膜直下に索状網状影を有する症例のCRT導入は慎重に判断し,放射線照射法を検討する必要がある。
目次
Definitive chemoradiotherapy(CRT)for esophageal cancer is the standard treatment and alternative to surgery. However, the tolerability of CRT in elderly patients is not well known. In this study, we retrospectively analyzed 60 patients with esophageal cancer who were treated with CRT(5—FU 700 mg/m2, cisplatin 70 mg/m2, radiation 60 Gy)at our hospital between January 2015 and September 2017. The patients were divided into 2 groups:an elderly group comprising 16 patients aged >75 years and a non—elderly group comprising 44 patients aged <74 years. The relative dose intensity of cisplatin in the elderly group was significantly lower than that in the non—elderly group. Radiotherapy was successfully executed in both groups. More patients in the elderly(25%)than the non—elderly group(7%)developed pneumonitis, and all patients who developed severe pneumonitis in the elderly group died. Application of definitive CRT and irradiation methods in elderly patients with a subpleural reticular shadow should be carefully considered before initiating therapy.
要旨
食道癌の根治的化学放射線療法(CRT)は非外科的治療を行う場合の標準治療であるが,高齢者の忍容性は明らかではない。そこで2015年1月～2017年9月に当院で根治的CRT[5—FU 700 mg/m2,シスプラチン(CDDP)70 mg/m2,放射線60 Gy]を行った食道癌60例を,高齢者群(75歳以上)16例と非高齢者群(74歳以下)44例の2群で後方視的に比較検討を行った。CDDPの相対用量強度は高齢者群で有意に低かった。放射線治療完遂症例の割合は両群でほぼ同等であった。有害事象は重篤な肺臓炎の発症割合が高齢者群25%,非高齢者群7%と高齢者群で多い傾向で,高齢者群の重篤な肺臓炎症例は全例治療関連死に至った。特に,高齢者で胸膜直下に索状網状影を有する症例のCRT導入は慎重に判断し,放射線照射法を検討する必要がある。