Katsumi Chihiro, Bamba Takeo, Nakagawa Satoru, Aizawa Masaki, Matsuki Atsushi, Yabusaki Hiroshi, Homma Keiichi
Dept. of Gastroenterological Surgery, Niigata Cancer Center Hospital.
Gan To Kagaku Ryoho. 2017 Jan;44(1):75-78.
A 59-year-old man was diagnosed with advanced thoracic esophageal cancer.He underwent neoadjuvant chemotherapy with cisplatin(CDDP), 5-fluorouracil(5-FU)(CF)followed by transthoracic esophagectomy with three-field lymphadenectomy. Histopathological examination revealed that the tumor was poorly differentiated squamous cell carcinoma invading the adventitia with 6 regional lymph node metastases.Four months after surgery, follow-up thoracic computed tomography (CT)showed multiple lung and mediastinal lymph node metastases.The patient's general condition was favorable, and he underwent systemic chemotherapy with docetaxel, CDDP, 5-FU(DCF).After 2 courses of DCF, chest CT revealed that the lung and mediastinal lymph node metastases had markedly decreased in size to the point of being unmeasurable.After receiving additional chemotherapy consisting of 2 courses of DCF and 8 courses of monthly docetaxel, the patient has been followed up without treatment.No tumor re-recurrence has occurred in the 6 years and 8 months since the first recurrence.In cases of recurrent or unresectable esophageal cancer, the rate of clinical response is reported to be higher for DCF than for CF. DCF is a tolerable regimen, even for postoperative patients, provided that monitoring is conducted for severe adverse events. In patients whose general conditions are favorable, DCF should be considered as a treatment option for recurrent esophageal cancer.
一名59岁男性被诊断为晚期胸段食管癌。他接受了顺铂(CDDP)、5-氟尿嘧啶(5-FU)(CF方案)的新辅助化疗,随后进行了经胸食管癌切除术及三野淋巴结清扫术。组织病理学检查显示肿瘤为低分化鳞状细胞癌,侵及外膜,伴有6个区域淋巴结转移。术后4个月,胸部计算机断层扫描(CT)随访显示多发肺及纵隔淋巴结转移。患者一般状况良好,接受了多西他赛、CDDP、5-FU(DCF方案)的全身化疗。2个疗程的DCF化疗后,胸部CT显示肺及纵隔淋巴结转移灶明显缩小至无法测量。在接受了2个疗程的DCF化疗及8个疗程每月1次的多西他赛化疗后,患者停止治疗并进行随访。自首次复发以来的6年8个月里未出现肿瘤复发。据报道,对于复发或不可切除的食管癌患者,DCF方案的临床缓解率高于CF方案。DCF方案是一种可耐受的治疗方案,即使对于术后患者也是如此,前提是对严重不良事件进行监测。对于一般状况良好的患者,DCF方案应被视为复发性食管癌的一种治疗选择。