Kaneko Kazuhiro, Ito Hiroaki, Konishi Kazuo, Kurahashi Toshinori, Katagiri Atsushi, Katayose Kohzo, Kitahara Tadashi, Ohtsu Atsushi, Mitamura Keiji
Second Department of Internal Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
Hepatogastroenterology. 2002 May-Jun;49(45):699-705.
BACKGROUND/AIMS: Definitive chemoradiotherapy can have curative potential in unresectable patients with malignant stricture due to locally advanced esophageal carcinoma, however, dysphagia is the principal problem in patients who had recurrence or who did not respond to chemoradiotherapy. In this prospective study, we investigated the efficacy and feasibility of metallic stent implantation for patients with dysphagia after chemoradiotherapy failed.
Concurrent chemoradiotherapy was performed in 40 patients with severe dysphagia due to esophageal squamous cell carcinomas accompanied by T3 or T4 disease containing M1 lymph node (LYM) disease. A self-expanding metallic stent was inserted for patients with malignant stricture of the thoracic esophagus after failure of chemoradiotherapy using identical protocols.
Of 40 patients, 13 (33%) achieved a complete response. However, 12 patients complained of severe dysphagia again after chemoradiotherapy despite a good performance status. Esophageal stricture of these 12 patients was caused by stable disease (n = 4), local progression (n = 5), and compression of metastatic lymph node (n = 3). Metallic stents were successfully inserted for all 12 patients, and dysphagia improved in 10 (83%) of these 12 patients. Life-threatening complication (17%) of sepsis in two patients was found in an early phase after stent insertion, although approximately 200 days had passed in a dysphagia-free state after chemoradiotherapy.
Implantation of self-expanding metallic stent for patients with malignant stricture after failure of chemoradiotherapy is effective, however, serious complication can occur in the early phase.
背景/目的：对于因局部晚期食管癌导致恶性狭窄的不可切除患者，确定性放化疗可能具有治愈潜力，然而，吞咽困难是复发患者或对放化疗无反应患者的主要问题。在这项前瞻性研究中，我们调查了金属支架植入术对放化疗失败后出现吞咽困难患者的疗效和可行性。
对40例因食管鳞状细胞癌伴T3或T4期疾病（含M1淋巴结转移）导致严重吞咽困难的患者进行同步放化疗。对于放化疗失败后出现胸段食管恶性狭窄的患者，采用相同方案插入自膨式金属支架。
40例患者中，13例（33%）达到完全缓解。然而，12例患者尽管身体状况良好，但放化疗后仍再次出现严重吞咽困难。这12例患者的食管狭窄由病情稳定（n = 4）、局部进展（n = 5）和转移性淋巴结压迫（n = 3）引起。12例患者均成功插入金属支架，其中10例（83%）吞咽困难得到改善。尽管放化疗后约200天处于无吞咽困难状态，但在支架插入后的早期发现2例患者出现危及生命的败血症并发症（17%）。
放化疗失败后恶性狭窄患者植入自膨式金属支架是有效的，然而，早期可能会出现严重并发症。
