Nakai Shigeto, Takeoka Tomohira, Okada Kazuyuki, Matsuno Hiroshi, Konishi Ken, Ota Hideo, Yokoyama Shigekazu, Fukunaga Mutsumi, Kobayashi Kenji
Dept. of Gastrointestinal Surgery, Hyogo Prefectural Nishinomiya Hospital.
Gan To Kagaku Ryoho. 2019 Mar;46(3):529-531.
A70s man was admitted to our hospital complaining of chest discomfort. Endoscopic examination showed mucosal erythema and irregularity and an area unstained by iodine in the middle esophagus 21 to 41 cm from the incisors. The biopsy specimen showed moderately differentiated squamous cell carcinoma. An abdominal computed tomographic(CT)scan revealed swelling of the lymph nodes along the celiac artery and abdominal aorta. The patient was diagnosed with unresectable advanced esophageal cancer(cT2N4M0, cStage Ⅳa). Systemic chemotherapy was initiated using a regimen of 5-FU and cisplatin(FP). After 2 courses of chemotherapy, an abdominal CT scan showed reduction of the lymph node swelling along the abdominal aorta, but the lymph node swelling remained along the celiac artery. Therefore, chemoradiotherapy(CRT; FP plus RT 60 Gy/30 Fr at the main tumor and the swelling of lymph nodes along the celiac artery)was administered. An abdominal CT scan showed reduced swelling of the lymph nodes along the abdominal aorta and the celiac artery after CRT. In addition, FP chemotherapy was also administered. APET -CT scan showed no increased FDG up take in the main tumor and swollen lymph nodes after 2 courses of chemotherapy. The complete response(CR)has been maintained for 30 months without therapy.
一名70岁男性因胸部不适入院。内镜检查显示黏膜红斑及不规则，在距门齿21至41厘米的食管中段有一处碘不着色区。活检标本显示为中分化鳞状细胞癌。腹部计算机断层扫描（CT）显示腹腔动脉和腹主动脉周围淋巴结肿大。该患者被诊断为不可切除的晚期食管癌（cT2N4M0，c期Ⅳa）。开始采用5-氟尿嘧啶和顺铂（FP）方案进行全身化疗。2个疗程化疗后，腹部CT扫描显示腹主动脉周围淋巴结肿大减轻，但腹腔动脉周围淋巴结肿大仍存在。因此，给予同步放化疗（CRT；在主肿瘤及腹腔动脉周围肿大淋巴结处给予FP加60 Gy/30次分割的放疗）。同步放化疗后腹部CT扫描显示腹主动脉和腹腔动脉周围淋巴结肿大减轻。此外，也给予了FP化疗。2个疗程化疗后，正电子发射断层扫描-CT（PET-CT）显示主肿瘤及肿大淋巴结处氟代脱氧葡萄糖（FDG）摄取未增加。完全缓解（CR）已维持30个月，未进行治疗。
