Yoshizawa Junichi, Koide Naohiko, Takeuchi Daisuke, Suzuki Akira, Shinoda Atsunori, Miyagawa Shinichi
Dept. of Surgery, Shinshu University School of Medicine, Japan.
Gan To Kagaku Ryoho. 2013 Mar;40(3):383-7.
The patient was a 59-year-old man showing an ulcerative tumor. He had squamous cell carcinoma diagnosed by biopsy specimens, found in the esophagogastric junction by esophagogastroduodenoscopy. Abdominal CT showed a No.7 nodeswelling( 40mm in diameter), and the metastatic tumor directly invaded the pancreas(cStage IVa). We scheduled surgery followed by chemoradiotherapy, because it was difficult to remove the metastatic node completely. Two courses of chemotherapy consisting of 5-FU and CDDP were performed, and 2 Gy/day-irradiation(total amount of 40 Gy)was performed over 20 days. After chemoradiation, the tumor changed to a superficially depressed lesion, and the metastatic huge node was shrunk. Thirty-five days after chemoradiation, transhiatal a lower esophagectomy with proximal gastrectomy was performed. Histopathologic findings after surgery showed no cancer remnant in the primary site and the node(pCR). Three years later, the patient is well without recurrence. Although there was no evidence of preoperative chemoradiation limited in squamous cell carcinoma of the esophagogastric junction, surgery followed by chemoradiotherapy may be an effective treatment in advanced cases, such as the present one.
患者为一名59岁男性，患有溃疡性肿瘤。经活检标本诊断为鳞状细胞癌，通过食管胃十二指肠镜检查发现位于食管胃交界处。腹部CT显示7区淋巴结肿大（直径40mm），转移瘤直接侵犯胰腺（cStage IVa）。由于难以完全切除转移淋巴结，我们安排了手术，随后进行放化疗。进行了两个疗程由5-氟尿嘧啶和顺铂组成的化疗，并在20天内进行了每天2Gy的照射（总量40Gy）。放化疗后，肿瘤变为浅表凹陷性病变，转移的巨大淋巴结缩小。放化疗35天后，进行了经胸下段食管切除术加近端胃切除术。术后组织病理学检查结果显示原发部位和淋巴结无癌残留（pCR）。三年后，患者情况良好，无复发。尽管术前放化疗对食管胃交界鳞状细胞癌的疗效尚无证据，但手术加放化疗可能是晚期病例（如本例）的有效治疗方法。
