Isono K, Koide Y
Second Dept. of Surgery, School of Medicine, Chiba University.
Gan To Kagaku Ryoho. 1993 Jul;20(9):1147-53.
Current multimodality treatment of thoracic esophageal carcinoma in our institution was described. The rate of superficial carcinomas is increasing in recent years, and they are treated by endoscopic mucosal resection (EMR), transhiatal esophagectomy (THE) or with the thoracotomy approach. Treatment is based on precise diagnosis of the depth of cancer invasion and nodal involvement using endoscopy with endoscopic ultrasound (EUS). Three-field lymphadenectomy for thoracic esophageal carcinoma, including superficial one, was started in 1983 as a standard operation, and its indications have been gradually decreasing for the past 10 years. As a result of accurate, individualized treatment, life table analysis revealed no significant difference between 2- and 3-field lymphadenectomy. Multimodality treatment of advanced cases is mainly composed of 3-field lymphadenectomy. Adjuvant chemotherapy of systemic therapy is regarded as more important than concurrent irradiation of local therapy. Recently powerful chemotherapy is becoming more frequent pre- or postoperatively. Our routine regimen is CDDP and infusional 5-FU with leucovorin as a biochemical modulator.
本文描述了我院目前对胸段食管癌的多模式治疗。近年来，表浅癌的发生率在上升，此类癌症通过内镜黏膜切除术（EMR）、经裂孔食管切除术（THE）或开胸手术进行治疗。治疗基于使用内镜超声（EUS）的内镜检查对癌症浸润深度和淋巴结受累情况进行精确诊断。包括表浅癌在内的胸段食管癌三野淋巴结清扫术于1983年开始作为标准手术，在过去10年中其适应证逐渐减少。经过准确、个体化的治疗，生命表分析显示二野和三野淋巴结清扫术之间无显著差异。晚期病例的多模式治疗主要包括三野淋巴结清扫术。全身治疗的辅助化疗被认为比局部治疗的同步放疗更重要。近来，强效化疗在术前或术后使用得越来越频繁。我们的常规方案是顺铂（CDDP）和持续输注5-氟尿嘧啶（5-FU）并使用亚叶酸作为生化调节剂。
