食道癌に対する根治的化学放射線療法後のsalvage食道切除  [in Japanese] Salvage Esophagectomy after Definitive Chemoradiotherapy for Esophageal Cancer  [in Japanese]

目的:食道癌治療における化学放射線療法(chemoradiotherapy;以下,CRT)の増加に伴い,CRT後の遺残・再発に対するsalvage食道切除例が増加している.当科のsalvage食道切除の治療成績を検討し,治療適応を考察した.方法:1986〜2008年に,50Gy以上のCRT施行後の遺残・再発に対し食道切除を施行した18例を対象とした.結果:cStage I-III(nonT4)/cStage III(T4)-IVaのCRTの効果は,有効6例/7例,無効1例/4例で,CRT終了から手術までの期間は,中央値6か月/2か月だった.前者/後者の手術根治度は,治癒切除2例/4例,姑息切除5例/7例だった.前者の術後1年生存率は,14%で2年生存例はなかった.後者の術後1,3,5年生存率は,おのおの36%,18%,9%だった(p=0.5725).治癒切除例の術後1,3,5年生存率は,おのおの83%,33%,17%だったが,姑息切除例では,1年生存例はなかった(p=0.0005).CRT有効例の術後1,3,5年生存率は,おのおの39%,15%,7%だったが,無効例では,1年生存例はなかった(p=0.0106).手術合併症は,17例(94%)に認め,重篤な合併症は姑息切除例での発生が多かった.salvage食道切除例の予後は,CRTの効果と手術根治度が関与しており,CRT前の進行度は予後に関与なかった.考察:salvage食道切除はCRTが有効な症例の再発で,治癒切除可能例においてのみその手術の意義があると考えられた.

Introduction: Definitive Chemoradiotherapy (CRT) for esophageal cancer has become common, raising the incidence of salvage esophagectomy for residual and recurrent tumors after definitive CRT. We investigated indications, for salvage esophagectomy based on outcome. Methods: We reviewed 18 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive CRT with more than 50Gy of radiation from 1986 to 2008. Results: Seven had cStage I-III (nonT4), and 11 cStage III (T4)-IVa before definitive CRT. Definitive CRT (former cStage/later cStage) resulted in responders for 6/7, non-responders for 1/4. Median duration definitive CRT to salvage esophagectomy (former cStage/later cStage) was 6/2 months. Curative surgery was underwent 2/4 (former cStage/later cStage) and palliative surgery was underwent 5/7 (former cStage/later cStage). One, 3 and 5-year survival after curative surgery was 83%, 33% and 17%. No patient survived more than one year after palliative surgery. One, 3 and 5-year survival after responders to CRT was 39%, 15% and 7%. No patient survived more than one year after non-responders. Morbidity was 94%. Postoperative severe complications occurred more after palliative surgery than after curative surgery. Hospital mortality occurred only palliative surgery. Survival was better among responders to CRT and in those undergoig curative surgery. There is no relation between cStage and survival. Conclusions: It appears to offer some survival benefit to responders to definitive CRT and to those undergoing curative surgery.