Matsutani Takeshi, Uchida Eiji, Maruyama Hiroshi, Suzuki Seiji, Yokoyama Tadashi, Matsushita Akira, Hirakata Atsushi, Kawamoto Masao, Arai Hiroki, Umakoshi Michinobu, Wakabayashi Hideyuki, Sasajima Koji
Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital.
Gan To Kagaku Ryoho. 2010 Oct;37(10):1949-52.
The patient, a 73-year-old male, was admitted to our hospital because of dysphagia. A far-advanced cancer was diagnosed at the esophagogastric junction by upper gastrointestinal endoscopic examination. Pathological biopsy examinations revealed poorly-differentiated adenocarcinoma. Computed tomography (CT) of the chest and abdomen showed invasion to the diaphragm. Clinical Stage was IV in an unresectable far-advanced tumor. He received radiation therapy (40 Gy/total, 2 Gy/day×20 times) in combination with chemotherapy using docetaxel (40 mg/m², day 1), nedaplatin (10mg/body, days 1-5) and 5-fluorouracil (500 mg/body, days 1-5). After this combination chemoradiation therapy (CRT), macroscopic examinations showed significant reductions in the size of tumor, leading a partial response according to the RECIST guidelines. He underwent total gastrectomy, partial resection of the lower esophagus via left thoracotomy, and Roux-en Y reconstruction with jejunostomy. Pathological examination of the resected specimens revealed Stage IV (T3N2P1CY0). The postoperative course was uneventful. He was treated on an outpatient basis without adjuvant therapy, and died 6 months after the operation by liver, spleen and lymph node metastases.
患者为一名73岁男性，因吞咽困难入院。上消化道内镜检查在食管胃交界处诊断出进展期癌症。病理活检显示为低分化腺癌。胸部和腹部计算机断层扫描（CT）显示肿瘤侵犯膈肌。临床分期为IV期，为不可切除的进展期肿瘤。他接受了放射治疗（总量40 Gy，2 Gy/天×20次），并联合使用多西他赛（40 mg/m²，第1天）、奈达铂（10mg/体，第1 - 5天）和5-氟尿嘧啶（500 mg/体，第1 - 5天）进行化疗。在这种联合放化疗（CRT）后，肉眼检查显示肿瘤大小显著缩小，根据RECIST标准达到部分缓解。他接受了全胃切除术、经左胸下段食管部分切除术以及空肠造口Roux-en-Y重建术。切除标本的病理检查显示为IV期（T3N2P1CY0）。术后过程顺利。他在门诊接受治疗，未进行辅助治疗，术后6个月因肝、脾和淋巴结转移死亡。
