食道癌術後再発に対する長期温熱療法の経験  [in Japanese] A Case of Recurrent Esophageal Cancer Treated with Chemoradiation Combined with Long-term Hyperthermia Treatment  [in Japanese]

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Author(s)

    • 大賀 才路 OHGA SAIJI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 掛地 吉弘 KAKEJI YOSHIHIRO
    • 九州大学大学院医学研究院消化器・総合外科 Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University
    • 本田 浩 HONDA HIROSHI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 中村 和正 NAKAMURA KATSUMASA
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 吉武 忠正 YOSHITAKE TADAMASA
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 塩山 善之 SHIOYAMA YOSHIYUKI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 大賀 丈史 OHGA TAKEFUMI
    • 九州大学大学院医学研究院消化器・総合外科 Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University
    • 佐々木 智成 SASAKI TOMONARI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 野々下 豪 NONOSHITA TAKESHI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 浅井 佳央里 ASAI KAORI
    • 九州大学大学院医学研究院臨床放射線科学 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
    • 森田 勝 MORITA MASARU
    • 国立病院機構九州がんセンター消化器外科 Department of gastroenterological surgery, National Hospital Organization Kyushu Cancer Center

Abstract

温熱療法は化学療法・放射線治療・手術などに比較して低侵襲な治療法である. しかし, 長期間温熱療法の安全性に関する報告は認められてない. 今回, 4年間の長期間に86回の温熱療法を施行した症例を報告する.<br> 症例は, 65歳男性, 胸部中部食道原発の進行性食道癌患者である. 食道癌に対する治療として, まず胃管再建による食道亜全摘術が施行された. しかし, 術後5ケ月目のCTにて上縦隔と左鎖骨上窩に再発巣を認めた. 再発病変に対する治療としては, 温熱療法併用下に化学放射線療法が施行された. 放射線治療は, 再発病巣へ線量60 Gyが投与され, 同時併用としてCDDPと5FUを含んだ化学療法が施行された. 温熱療法は, RF誘電加温装置 (サーモトロンRF-8, 山本ビニター社製) にて週2回, 50分/回の治療が行われた. 治療終了時の評価CTでは, 病変の縮小を認めた. 追加治療としてCDDPとTS-1による化学療法と週2回の温熱療法を2週間施行した.<br> その後, 再々発予防目的に週1回もしくは3週に1回の割合で温熱療法を3年半継続した. 現在, 長期間温熱療法に伴う明らかな有害事象は認められておらず, また, 再々発病変も認められていない.

Hyperthermia is a less invasive treatment than chemotherapy, radiotherapy and surgery. However, there has been no report about the safety of administering repeated hyperthermia treatments over a long period. This report describes a patient who received 86 hyperthermia treatments over the course of four years.<br> A 65-year-old man was diagnosed with advanced esophageal cancer in the middle portion of the thoracic esophagus. He underwent a subtotal esophagectomy with gastric tube reconstruction. Five months after surgery, recurrent lesions were revealed on a computed tomography (CT) examination in the upper mediastinum and left supraclavicular region. Chemoradiation with a total dose of 60 Gy was performed in combination with hyperthermia as an initial treatment for these recurrences. Concurrent chemotherapy consisted of cisplatin (CDDP) and 5-fluorouracil (5FU). Hyperthermia was applied with an RF-capacitive heating apparatus (Thermotron RF-8, Yamamoto Vinita, Osaka, Japan) for 50 minutes twice a week. On a CT examination at the end of two months, both of the recurrent masses had decreased in size. Therefore, chemotherapy using CDDP and tegafur-uracil (TS-1), combined with twice-weekly hyperthermia, was performed as an adjuvant therapy for two weeks. Subsequently, he continued to receive hyperthermia once a week or once every three weeks for 3.5 years. At present he has had no adverse effects associated with the hyperthermia and no recurrence.

Journal

  • Thermal Medicine

    Thermal Medicine 28(1), 17-22, 2012

    Japanese Society for Thermal Medicine

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