食道癌に対する治療の動向とハイパーサーミアの役割 [in Japanese] Current Treatment and Application of Hyperthermia for Squamous Cell Carcinoma of the Esophagus [in Japanese]
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食道癌の治療において外科的切除はgold standardといえるが，成績向上には術前後の補助療法が重要である．切除可能なcStage II, III食道癌に対しては，欧米では術前化学放射線療法（CRT）後に根治術を行うことが多いが，本邦ではJCOGを中心とした臨床試験の結果より術前化学療法を行うことが現時点での標準療法とされている．我々は食道癌の予後向上を目指して腔内加温装置を開発し臨床応用した．その結果，術前CRTに温熱を加えたるとより高い組織学的治療効果が得られ，有意に予後が良好であることを報告した．近年，我々は根治的CRT後の遺残や再発に対するサルベージ治療として，化学療法に温熱療法を加え良好な成績を得た．本治療は，外来治療が可能で，重篤な有害事象も認めず，サルベージ治療として意義のあるものと考えられた．現在，食道癌に新たな化学療法や分子標的薬が応用されつつあり，これらの薬剤と温熱の併用効果を検討することにより，難治性の食道癌に対する治療として温熱療法が再び脚光を浴びる日がくること期待している．
Squamous cell carcinoma of the esophagus (ESCC) is a fairly aggressive disease with a poor prognosis. Surgical resection has been the gold standard of treatment for localized ESCC. However, this carcinoma is fairly sensitive to radiation, as well as chemotherapeutic agents such as cisplatin and 5-fluorouracil. Based on clinical trials conducted mainly by the Japan Clinical Oncology Group (JCOG), preoperative chemotherapy is regarded as the standard treatment for resectable ESCC in Japan. We have applied hyperthermia to ESCC mainly as a preoperative treatment associated with chemoradiotherapy since it has been experimentally proven to enhance the anti-tumor effects of chemotherapeutic agents and irradiation. The long-term survival as well as histological effectiveness was reported to be better in patients who received preoperative hyperthermochemoradiotherapy (HCR) than in those who received preoperative chemoradiotherapy (CRT). Definitive CRT is frequently performed even for resectable ESCC, and salvage treatment for either remnant or recurrent diseases remains an important clinical problem. We have applied hyperthermia simultaneously with chemotherapy as a salvage treatment for such patients, and complete response as well as stable disease was achieved in several patients. Hyperthermia is a promising modality as a salvage treatment and has recently been incorporated into regimens including taxanes. Potential enhancement of hyperthermia with certain drugs should be experimentally evaluated, and the clinical application of hyperthermia may be warranted with other newly-developed regimens.
- Thermal Medicine
Thermal Medicine 33(3), 63-73, 2017
Japanese Society for Thermal Medicine