気管分岐部へ進展する中心型扁平上皮癌に対して光線力学的治療,管状肺葉切除,陽子線治療で根治を得た1例  [in Japanese] Multimodality Therapy with Photodynamic Therapy, Sleeve Lobectomy and Proton Irradiation Curing a Central Type Bronchial Squamous Cell Carcinoma Spreading to the Tracheal Carina  [in Japanese]

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Abstract

<b>背景.</b>中心型扁平上皮癌は中枢気道へ腫瘍進展を来すことがあり,肺機能温存と治療方法に配慮を要する.<b>症例.</b>58歳,男性.健康診断の喀痰細胞診で異常を認めた.気管支鏡検査では,右主気管支末梢の膜様部と右B<sup>3</sup>aに結節隆起型病変を認めた.自家蛍光観察所見では,同病変から気管分岐部と中間気管支幹へ広がる自家蛍光の減弱を認めた.生検により扁平上皮癌と診断,気管分岐部と左主気管支入口部,中間気管支幹への腫瘍進展を確認した.表層進展と考えられた気管分岐部,左主気管支入口部,中間気管支幹にまず光線力学的治療(PDT)を行い,その1カ月後に右肺上葉管状切除術を施行した.中枢,末梢の気管支切除断端双方に腫瘍細胞の残存を認め,手術1カ月後から陽子線治療を追加した.その後は慎重に経過観察し,7年間無再発生存であった.<b>結論.</b>右上葉支から気管分岐部へ浸潤する中枢型扁平上皮癌に対して,PDT,管状肺葉切除,陽子線治療による集学的治療で中下葉を温存し,重篤な合併症はなく腫瘍の根治を得た.

<b><i>Background.</i></b> A central type bronchial squamous cell carcinoma sometimes spreads along the bronchial wall to the tracheal carina, which requires complicated treatment-strategies for radical cure and preservation of pulmonary function. <b><i>Case.</i></b> A 58-year-old man had a medical checkup and abnormal of sputum cytology was detected. Bronchoscopy revealed nodular lesions on a membranous portion of the peripheral right main bronchus, and right B<sup>3</sup>a. Autofluorescence imaging showed an abnormal area on the tracheal carina, right main bronchus and truncus intermedius. Bronchial biopsies resulted in a pathological diagnosis of squamous cell carcinoma, and showed tumor invasion to the tracheal carina, orifice of the left main bronchus and truncus intermedius. Photodynamic therapy (PDT) of the tracheal carina, and the orifice of the left main bronchus and truncus intermedius was undergone. One month after PDT, right sleeve upper lobectomy was performed. Because cancer cells remained at both bronchial resected margins, proton irradiation was added one month after surgery instead of additional bronchial resection. Then, he had a careful checkup and was alive for seven years without cancer recurrence. <b><i>Conclusion.</i></b> Multimodality therapy with PDT, sleeve lobectomy and proton irradiation was performed for bronchial squamous cell carcinoma spreading to the tracheal carina, which could lead to radical cure of tumor, preservation of the right middle and lower lobe. A good clinical course without severe complications was obtained.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 38(2), 107-113, 2016

    The Japan Society for Respiratory Endoscopy

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