内容紹介
A Case of Squamous Cell Carcinoma of the Esophagogastric Junction with Bulky No.7-Metastatic Node Successfully Treated by Chemoradiation Followed by Surgery
Summary
The patient was a 59-year-old man showing an ulcerative tumor. He had squamous cell carcinoma diagnosed by biopsy specimens, found in the esophagogastric junction by esophagogastroduodenoscopy. Abdominal CT showed a No.7 node-swelling(40 mm in diameter), and the metastatic tumor directly invaded the pancreas(cStageⅣa). We scheduled surgery followed by chemoradiotherapy, because it was difficult to remove the metastatic node completely. Two courses of chemotherapy consisting of 5-FU and CDDP were performed, and 2 Gy/day-irradiation(total amount of 40 Gy)was performed over 20 days. After chemoradiation, the tumor changed to a superficially depressed lesion, and the metastatic huge node was shrunk. Thirty-five days after chemoradiation, transhiatal a lower esophagectomy with proximal gastrectomy was performed. Histopathologic findings after surgery showed no cancer remnant in the primary site and the node(pCR). Three years later, the patient is well without recurrence. Although there was no evidence of preoperative chemoradiation limited in squamous cell carcinoma of the esophagogastric junction, surgery followed by chemoradiotherapy may be an effective treatment in advanced cases, such as the present one.
要旨 患者は59歳の男性で,内視鏡検査で食道胃接合部に不整形の潰瘍性病変を認め,生検で扁平上皮癌と診断された。腹部CTでNo. 7リンパ節の腫大を認め(直径40 mm),膵浸潤が強く疑われた。cStageⅣaで根治切除が困難である可能性を考慮し,術前化学放射線療法として5-FUおよびCDDPによる化学療法2コースと40 Gyの放射線外照射を行った。化学放射線療法後の内視鏡検査では原発巣は浅い陥凹性病変となり,CTではNo. 7リンパ節は著明な縮小を認めた。化学放射線療法後35日目に経裂孔的下部食道噴門側胃切除を行った。病理組織学的検査所見では,原発巣,リンパ節転移巣ともにpCRで,術後3年を経過して無再発生存中である 。食道胃接合部の扁平上皮癌に対する術前化学放射線療法のエビデンスは少ないが,本例のような進行癌症例に対してtrimodality therapyは有用な治療選択肢となり得ると考えられた。
目次
Summary
The patient was a 59-year-old man showing an ulcerative tumor. He had squamous cell carcinoma diagnosed by biopsy specimens, found in the esophagogastric junction by esophagogastroduodenoscopy. Abdominal CT showed a No.7 node-swelling(40 mm in diameter), and the metastatic tumor directly invaded the pancreas(cStageⅣa). We scheduled surgery followed by chemoradiotherapy, because it was difficult to remove the metastatic node completely. Two courses of chemotherapy consisting of 5-FU and CDDP were performed, and 2 Gy/day-irradiation(total amount of 40 Gy)was performed over 20 days. After chemoradiation, the tumor changed to a superficially depressed lesion, and the metastatic huge node was shrunk. Thirty-five days after chemoradiation, transhiatal a lower esophagectomy with proximal gastrectomy was performed. Histopathologic findings after surgery showed no cancer remnant in the primary site and the node(pCR). Three years later, the patient is well without recurrence. Although there was no evidence of preoperative chemoradiation limited in squamous cell carcinoma of the esophagogastric junction, surgery followed by chemoradiotherapy may be an effective treatment in advanced cases, such as the present one.
要旨 患者は59歳の男性で,内視鏡検査で食道胃接合部に不整形の潰瘍性病変を認め,生検で扁平上皮癌と診断された。腹部CTでNo. 7リンパ節の腫大を認め(直径40 mm),膵浸潤が強く疑われた。cStageⅣaで根治切除が困難である可能性を考慮し,術前化学放射線療法として5-FUおよびCDDPによる化学療法2コースと40 Gyの放射線外照射を行った。化学放射線療法後の内視鏡検査では原発巣は浅い陥凹性病変となり,CTではNo. 7リンパ節は著明な縮小を認めた。化学放射線療法後35日目に経裂孔的下部食道噴門側胃切除を行った。病理組織学的検査所見では,原発巣,リンパ節転移巣ともにpCRで,術後3年を経過して無再発生存中である 。食道胃接合部の扁平上皮癌に対する術前化学放射線療法のエビデンスは少ないが,本例のような進行癌症例に対してtrimodality therapyは有用な治療選択肢となり得ると考えられた。