Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
Surg Today. 2013 May;43(5):556-61. doi: 10.1007/s00595-012-0240-7. Epub 2012 Jul 1.
A 57-year-old male with lower esophageal cancer underwent subtotal esophagectomy with lymphadenectomy. The histopathological diagnosis was poorly differentiated squamous cell carcinoma, pT2N1M0 pStageIIB. After one course of postoperative adjuvant chemotherapy involving low-dose CDDP/5FU, a PET-CT scan obtained 12 months after surgery revealed a solitary liver metastasis in the S2 area. The patient then underwent five courses of docetaxel chemotherapy (80 mg/body, tri-weekly), and a partial response was observed. We also performed radiofrequency ablation (RFA), after which a complete response was observed. Twenty months after surgery, we detected local liver recurrence in the same position and performed additional RFA. Twenty-four months after surgery, a solitary lung metastasis was detected in the left S2 area and the patient was administered five additional courses of docetaxel therapy. Subsequently, PET-CT revealed growth of lung and liver tumors without recurrence in other areas. Twenty-nine months after surgery, we partially excised metastatic liver and lung tumors, and no subsequent recurrence has since been detected. The prognoses of patients who suffer from esophageal cancer organ recurrence are known to be extremely poor, and optimal therapeutic strategies for treating these patients have not been established. This long-term survival case suggests that multidisciplinary therapy for the treatment of liver and lung recurrence after esophagectomy is effective.
一位 57 岁男性因下段食管癌接受了食管次全切除术和淋巴结清扫术。组织病理学诊断为低分化鳞状细胞癌,pT2N1M0 pStageIIB。手术后接受了一个疗程的含低剂量顺铂/5-FU 的辅助化疗,术后 12 个月的 PET-CT 扫描显示 S2 区有单发肝转移。随后,患者接受了五轮多西紫杉醇化疗(80mg/体,每三周一次),观察到部分缓解。我们还进行了射频消融(RFA),之后观察到完全缓解。手术后 20 个月,我们在同一部位检测到局部肝复发,并进行了额外的 RFA。手术后 24 个月,左侧 S2 区发现单发肺转移,给予患者另外五轮多西紫杉醇治疗。随后,PET-CT 显示肺部和肝脏肿瘤生长,但其他部位无复发。手术后 29 个月,我们部分切除了肝和肺转移瘤,此后未再发现复发。已知患有食管癌器官复发的患者预后极差,尚未确定针对这些患者的最佳治疗策略。这个长期生存的病例表明,多学科治疗对于治疗食管癌手术后的肝肺复发是有效的。