日本消化器外科学会教育集会

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あまめかわらい
7 years ago
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1 Medical oncology T4N4M1 I 1T4 T4 T4 T4 1 T4 down-staging T4 40Gy R0 down-staging R0 2 T440Gy 20Gy 3 T460Gy 4 T4 down-staging T4 43

2 R0 T4 1 T436Gy R0 T R0 Salvage T4 Lerut T3-4 Locally advanced 36-40Gy 7 T4 61 T CR down-staging Stahl Locally advanced 40Gy 65Gy 8 T Locally advanced T4 T4 downstaging 2 T4 full-dose Locally advanced 9 T4 M1LYM 10 CR T4 M1LYM CR T350 T425 Crosby T466 M1LYM T4 11 JCOG T4 M1LYM CR FU 14 T4 CR 32T4M0 227 JCOG Phase II 15 T4 44

3 CR N4 N4 Medical oncologist UICC TNM M Celiac axis TNM M1 M1a Celiac axis lymphadenopathy M.D. Anderson EUS 18 Marsman EUS 19 Medical oncologist IM T N M T1IM

4 23 II Salvage 1Salvage Stage I T2 Salvage Salvage salvage surgery Salvage 50Gy 50Gy Salvage 44Gy 3070Gy 4 Salvage 27 T1-T2 322 Salvage T3-T423 5 Salvage Salvage Salvage Salvage 5 Salvage Salvage 33 Salvage Salvage Stage I 130 CR 9532 Salvage Salvage Stage IIIII CR 6528 Salvage Salvage Stage IV 28 CR 32 CR 4 Salvage Salvage CR Salvage 2 Stage 46

5 図 1 StageI, I の治療効果図 2 Chemoradiotherapy の生存曲線 47

6 Salvage Salvage Salvage 2Salvage Cleveland Clinic 5.945Gy Siewert ECOG 60Gy Gy MD Swisher 13 Salvage 39 Salvage 15 Medical oncologist 60Gy Salvage Salvage Salvage Salvage 10 1 Salvage 呼吸器合併症消化器合併症循環器合併症感染合併症在院期間 30 日以内 31 日以上在院死表 1 食道切除術後合併症 Salvage (n=58) 20 (34%) 19 (33%) 5(9%) 11 (19%) 34 (59%) 17 (29%) 7(12%) 術前無治療 (n=185) 51 (28%) 34 (18%) 7(4%) 21 (11%) 147 (80%) 32 (17%) 6(3%) 表 2 食道切除術後の気管気管支壊死穿孔症例気管支動脈頸部郭清再建経路他の因子予後 No.1 No.2 No.3 No.4 No.5 切除温存切除温存温存ありありありありなし胸骨後胸骨後胸骨後後縦隔後縦隔頸部縫合不全縦隔炎胃管先端壊死縦隔炎胃管先端壊死縦隔炎死亡生存死亡死亡死亡 48

7 図 3 食道切除術後生存曲線 2 Salvage 3 Salvage 10 Salvage 3Salvage Salvage 50Gy Salvage 2745Gy Salvage Salvage T3 49

8 III self-expandable metallic stent Yano M, Tsujinaka T, Shiozaki H, et al. Concurrent chemotherapy5-fluorouracil and cisplatinand radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus. J Surg Oncol , Yano M, Shiozaki H, Tsujinaka T, et al. Squamous cell carcinoma of the esophagus infiltrating the respiratory tract is less sensitive to preoperative concurrent radiation and chemotherapy. J Am Coll Surg , Noguchi T, Moriyama H, Wada S, et al. Resection surgery with neoadjuvant chemoradiotherapy improves outcomes of patients with T4 esophageal carcinoma. Dis Esophagus , Ikeda K, Ishida K, Sato N, et al. Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. Dis Esophagus , Fujita H, Sueyoshi S, Tanaka T, et al. Prospective non-randomized trial comparing esophagectomy-followed-by-chemoradiotherapy versus chemoradiotherapy-followed-byesophagectomy for T4 esophageal cancers. J Surg Oncol ,

9 Fujita H, Sueyoshi S, Tanaka T, et al. Esophagectomy is it necessary after chemoradiotherapy for a locally advanced T4 esophageal cancer? Prospective nonrandomized trial comparing chemoradiotherapy with surgery versus without surgery. World J Surg , Hagry O, Coosemans W, De Leyn P, et al. Effects of preoperative chemoradiotherapy on postsurgical morbidity andmortalityinct3-4 cm1lymph cancer of the oesophagus and gastro-oesophageal junction. Eur J Cardiothorac Surg , Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol , Ohtsu A, Yoshida S, Boku N, et al. Concurrent chemotherapy and radiation therapy for locally advanced carcinoma of the esophagus. Jpn J Clin Oncol , OhtsuA,BokuN,MuroK,etal.Definitive chemoradiotherapy for T4 andor M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol , Crosby TD, Brewster AE, Borley A, et al. Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer , Ishida K, Iizuka T, Ando N, Ide H. Phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagusnine Japanese institutions trial. Jpn J Clin Oncol , Ishida K, Ando N, Yamamoto S, Ide H, Shinoda M. Phase II study of cisplatin and 5- fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus a Japan Esophageal Oncology Group JEOG Japan Clinical Oncology Group trialjcog9516. Jpn J Clin Oncol , Nishimura Y, Suzuki M, Nakamatsu K, et al. Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula. Int J Radiat Oncol Biol Phys , JCOG JCOG0303phaseIIIII Low Dose Cisplatin5- FU Standard Dose Cisplatin5-FU IIIII 16Tachimori Y, Kato H, Watanabe H. Surgery for thoracic esophageal carcinoma with clinically positive cervical nodes. J Thorac Cardiovasc Surg , Igaki H, Kato H, Tachimori Y, Sato H, Daiko H, Nakanishi Y. Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothorac Surg , Malaisrie SC, Hofstetter WL, Correa AM, et al. Endoscopic ultrasonography-identified celiac adenopathy remains a poor prognostic factor despite preoperative chemoradiotherapy in esophageal adenocarcinoma. J Thorac Cardiovasc Surg , Marsman WA, van Wissen M, Bergman JJ, et al. Outcome of patients with esophageal carcinoma and suspicious celiac lymph nodes as determined by endoscopic ultrasonography. Endoscopy , Natsugoe S, Yoshinaka H, Shimada M, et al. Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in 51

10 patients with esophageal carcinoma. Ann Surg , Kato H, Tachimori Y, Watanabe H, et al. Intramural metastasis of thoracic esophageal carcinoma. Int J Cancer , Yuasa N, Miyake H, Yamada T, et al. Prognostic significance of the location of intramural metastasis in patients with esophageal squamous cell carcinoma. Langenbecks Arch Surg , Hokamura N, Kato H, Tachimori Y, et al. Preoperative chemotherapy for esophageal carcinoma with intramural metastasis. J Surg Oncol , Kato H, Udagawa H, Togo A, et al. For the Japan Clinical Oncology GroupJCOG. A phase II trial of chemo-radiotherapy in patients with stage I esophageal squamous cell carcinomajapan Clinical Oncology Group studyjcog9708abstract No1147 Proc Am Soc Clin Oncol , Hattori S, Muto M, Ohtsu A, et al. EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc , Ohtsu A. Chemoradiotherapy for esophageal cancercurrent status and perspectives. Int J Clin Oncol , Murakami M, Kuroda Y, Okamoto Y, et al. Neoadjuvant concurrent chemoradiotherapy followed by definitive high-dose radiotherapy or surgery for operable thoracic esophageal carcinoma. Int J Radiat Oncol Biol Phys , Murakami M, Kuroda Y, Nakajima T, et al. Comparison between chemoradiation protocol intended for organ preservation and conventional surgery for clinical T1-T2 esophageal carcinoma. Int J Radiat Oncol Biol Phys , Murakami M, Kuroda Y, Matsusue S, et al. Treatment results of esophageal carcinoma of clinical T3, T4M0historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery. Oncol Rep , controversysalvage surgery , , salvage , Salvage , Chidel MA, Rice TW, Adelstein DJ, et al. Resectable esophageal carcinomalocal control with neoadjuvant chemotherapy and radiation therapy. Radiology , Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomyprevalence, predisposing factors and outcome. Br J Surg , Fujita H, Hawahara H, Yamana H, et al. Mediastinal lymph node dissection procedure during esophageal cancer operation carefully considered for preserving respiratory function. Jpn J Surg , Keller SM, Ryan LM, Coia LR, et al. High dose chemoradiotherapy followed by esophagectomy for adenocarcinoma of the esophagus and gastroesophageal junctionresults of a phase II study of the Eastern Coopera- 52

11 tive Oncology Group. Cancer , Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 Radiation Therapy Oncology Group phase III trial of combinedmodality therapy for esophageal cancer high-dose versus standard-dose radiation therapy. J Clin Oncol , Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg , , Sakuraba M, Kimata Y, Hishinuma S, et al. Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy. Plast Reconstr Surg , Nakamura T, Hayashi K, Ota M, et al. Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg , Nishimura Y, Nagata K, Katano S, et al Japanese Society for Esophageal Diseases. Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stentsa questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Biol Phys , Sumiyoshi T, Gotoda T, Muro K, et al. Morbidity and mortality after self-expandable metallic stent placement in patients with progressive or recurrent esophageal cancer after chemoradiotherapy. Gastrointest Endosc ,

食道がん化学放射線療法後のsalvage手術

食道がん化学放射線療法後のsalvage手術 2006 2 17 52 Daly JM, et al. J Am Coll Surg 2000;190:562-573 Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573