内容紹介
Complete Response in Far-Advanced Esophageal Cancer Treated with Induction Chemotherapy Followed by Definitive Chemoradiotherapy
Summary
We report a case of far-advanced esophageal cancer in which induction chemotherapy followed by chemoradiotherapy achieved complete remission. A 61-year-old female presented to our hospital with dyspnea and hoarseness. CT revealed a tumor at the cervical esophagus invading and narrowing the trachea, a bulky metastasis at the right paraesophageal node, and nodal metastases at levels Ⅱ and Ⅲ of the left neck. No finding indicated other distant metastases. According to findings of CT and endoscopy, she was diagnosed with unresectable cancer at the cervical esophagus(cT4bN1M1[LYM], according to UICC-TNM 7 th). After 2 courses of induction chemotherapy(DTX, CDDP, and 5-FU), the tumor's volume was remarkably reduced. Thereafter, chemoradiotherapy with CDDP, 5-FU, and 60 Gy/30 Fr was administered. After 7 months of systemic chemotherapy with paclitaxel following chemoradiotherapy, the patient was judged to have complete remission based on CT and endoscopic findings. After additional administration of S-1 for 5 months, systemic chemotherapy was ceased. The patient has survived without disease progression for 22 months following initiation of treatment. It is thought that induction chemotherapy followed by chemoradiotherapy might improve local control and survival of patients with far-advanced esophageal cancers, such as our patient.
要旨
cT4食道癌においては化学放射線療法(CRT)が標準療法とされるが,その生命予後は不良である。今回われわれは,気管狭窄を伴うcT4頸部食道癌に対して導入化学療法後のCRTが著効した症例を経験したので報告する。症例は61歳,女性。呼吸苦および嗄声を契機に,切除不能高度進行頸部食道癌(cT4N2M0,cStage Ⅳa)と診断された。DCF療法による導入化学療法を2コース施行し,著明な腫瘍縮小を得た後にCRTを施行した。CRT施行後,weekly PTX療法を7か月,S-1投与を5か月継続したがCRを維持したため,以降は無治療で経過観察している。治療開始から22か月にわたり無増悪生存中である。導入化学療法後のCRTは,本症例のような高度進行食道癌に対する有効な治療法となり得るものと考えられた。
目次
Summary
We report a case of far-advanced esophageal cancer in which induction chemotherapy followed by chemoradiotherapy achieved complete remission. A 61-year-old female presented to our hospital with dyspnea and hoarseness. CT revealed a tumor at the cervical esophagus invading and narrowing the trachea, a bulky metastasis at the right paraesophageal node, and nodal metastases at levels Ⅱ and Ⅲ of the left neck. No finding indicated other distant metastases. According to findings of CT and endoscopy, she was diagnosed with unresectable cancer at the cervical esophagus(cT4bN1M1[LYM], according to UICC-TNM 7 th). After 2 courses of induction chemotherapy(DTX, CDDP, and 5-FU), the tumor's volume was remarkably reduced. Thereafter, chemoradiotherapy with CDDP, 5-FU, and 60 Gy/30 Fr was administered. After 7 months of systemic chemotherapy with paclitaxel following chemoradiotherapy, the patient was judged to have complete remission based on CT and endoscopic findings. After additional administration of S-1 for 5 months, systemic chemotherapy was ceased. The patient has survived without disease progression for 22 months following initiation of treatment. It is thought that induction chemotherapy followed by chemoradiotherapy might improve local control and survival of patients with far-advanced esophageal cancers, such as our patient.
要旨
cT4食道癌においては化学放射線療法(CRT)が標準療法とされるが,その生命予後は不良である。今回われわれは,気管狭窄を伴うcT4頸部食道癌に対して導入化学療法後のCRTが著効した症例を経験したので報告する。症例は61歳,女性。呼吸苦および嗄声を契機に,切除不能高度進行頸部食道癌(cT4N2M0,cStage Ⅳa)と診断された。DCF療法による導入化学療法を2コース施行し,著明な腫瘍縮小を得た後にCRTを施行した。CRT施行後,weekly PTX療法を7か月,S-1投与を5か月継続したがCRを維持したため,以降は無治療で経過観察している。治療開始から22か月にわたり無増悪生存中である。導入化学療法後のCRTは,本症例のような高度進行食道癌に対する有効な治療法となり得るものと考えられた。