Department of Radiology, Osaka Kouseinenkin Hospital, Fukushima-ku, Osaka, Japan,
Jpn J Radiol. 2010 Apr;28(3):227-30. doi: 10.1007/s11604-009-0402-8. Epub 2010 May 1.
An 86-year-old man with dysphagia underwent gastrointestinal fiberscopy (GIF) and was found to have a circumferential type 3 advanced carcinoma in the upper thoracic esophagus and a type 2 tumor in the posterior wall of the gastric body. Microscopic examination of biopsy specimens of both tumors demonstrated moderately differentiated squamous cell carcinoma. He was diagnosed as having stage IVb (T3N0M1b) esophageal carcinoma with gastric wall metastasis. A total of 60 Gy in 30 fractions of three-dimensional conformal radiation therapy (3D-CRT) was first administered to the esophageal carcinoma, next to the gastric wall metastasis. Concurrent chemotherapy was not given because of the patient's refusal. No subjective morbidity was observed during the treatment. In the GIF study immediately after 3D-CRT, both esophageal and gastric wall tumors had attained a complete response. The dysphagia dissolved as the esophageal tumor shrunk. The patient has been doing well for 17 months after the start of 3D-CRT. No local recurrence was observed in either the esophagus or the stomach during follow-up GIF. Considering the dismal prognosis of esophageal carcinoma patients with intramural metastasis to the stomach, a watchful follow-up is needed.
一位 86 岁吞咽困难男性患者接受了胃肠纤维内镜检查（GIF），发现其食管上段存在环形 3 型进展期癌，胃体后壁存在 2 型肿瘤。两个肿瘤活检标本的显微镜检查均显示为中分化鳞状细胞癌。他被诊断为 IVb 期（T3N0M1b）食管癌伴胃壁转移。首先对食管癌及其胃壁转移灶给予 30 次分割的三维适形放射治疗（3D-CRT），共 60Gy。由于患者拒绝，未给予同期化疗。治疗过程中未观察到任何主观不良反应。在 3D-CRT 后立即进行的 GIF 研究中，食管和胃壁肿瘤均达到完全缓解。随着食管肿瘤缩小，吞咽困难消失。3D-CRT 开始后 17 个月，患者状况良好。随访 GIF 期间，食管和胃均未观察到局部复发。考虑到食管癌伴胃壁内转移患者的预后不佳，需要密切随访。
