Table 1. Autopsied patients and tumor characteristics.
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1 UTOPSY FINDINGS IN 40 CSES OF ESOPHGEL CNCER TRETED WITH RDITION THERPY Michitk YMKW*1, Kzumi SHIOJIM*1, Mstoshi HSEGW*1, Iwo HSHID*1, Tkeo TKHSHI*1, Ttsuy OHNO*1, Reiko IMI*1, Norio MITSUHSHI*1, Yoichi NKZTO*2 nd Hideo NIIBE*1 (Received 12 December 1994, ccepted 25 My 1995) bstrct We nlyzed locl control, lymph node metstses nd distnt metstses for utopsy cses of esophgel cncer treted with rdition therpy lone. Between Jnury 1980 nd October 1994, 40 utopsy cses of esophgel cncer treted by rdition therpy without surgery were investigted. This figure ccounts for 21% of the ptients wtih esophgel cncer treted t our deprtment during the sme period. Subjects were 32 mles nd 8 femles ged 42 to 84 (men=69 yers). Thirty-eight ptients hd squmous cell crcinom, one ptient hd denosqumous crcinom nd one ptient hd undifferentited crcinom. Sixteen ptients received totl dose less thn 60 Gy nd 24 ptients received 60 Gy or more. Durtions between strt of rdition therpy nd utopsy were s follows: 11 ptients within 3 months, 18 ptients within 1 yer, 3 ptients within 2 yers, 6 ptients within 5 yers, 2 ptients over 5 yers (65 months nd 145 months). The 1-yer, 3-yer, 5-yer overll survivl rtes by Kpln-Meier method were 45.8%, 16.7%, 8.3%, respectively. Four ptients (10%) were free of tumors, nd nother six ptients (15%) hd no primry tumor but metstses. Thirty ptients hd persistent or recurrent primry tumors. Locl tumor control rtes were 25% for ll ptients nd 34% for ptients who survived more thn 3 months nd 33% for ptients irrdited with 60Gy or more. Tumor type, tumor length nd survivl times were significntly relted with tumor control rtes. Perfortions into neighboring orgns were observed in eighteen ptients (45%); 12 ptients were perforted into respirtory systems, 4 ptients into vsculr systems, 1 into the medistinum nd 1 into the pleurl cvity. Thirty-two ptients (80%) hd lymph node metstses; 2 ptients with n2, 7 with n3, 23 with n4 regions. Twenty-seven ptients (68%) hd distnt metstses; 20 ptients in the lung, 19 in the liver, 10 in the stomch, 8 in the pncres nd the drenl glnd, 7 in the pleur, 6 in the bone nd the hert nd the diphrgm. Concurrent double cncer ws observed t utopsy in six ptients; 2 erly gstric cncers, 2 ltent heptoms, 1 lung cncer, 1 ltent thyroid cncer. Three ptients hd history of resection of other cncer before rdition therpy to esophgel cncer; 2 ptients hd gstric cncer nd 1 ptient hd submndibulr cncer. One ptient who hd nother esophgel cncer prt from the first esophgel cncer received rdition therpy 12 yers go. In conclusion, the locl control rte ws 33% for utopsy cses of esophgel cncer treted with rdition therpy of 60Gy or more. Tumor type, tumor length nd survivl times were significntly relted with tumor control rtes. Key words: Esophgel cncer, Rdition therpy, utopsy
2 Table 1. Autopsied patients and tumor characteristics.
3 食道 癌剖検 症例 の検 討 189 治 療 開 始 か ら剖 検 ま で の 期 間 と病 期 の 関 連 につ い て,Fig.1に 示 す.1年 以 内 の 死 亡 例 は1例 を 除 き, IV度 症 例 で あ っ た.1年 I III度 以 上 の 生 存 例 は11例 症 例 が8例(73%)で あ っ た.5年 存 し た2例 の 生 存 期 間 は,そ 月(12年)で れ ぞ れ65か で, 以上 生 月,145か あ っ た. 照 射 線 量 別 の 生 存 率 曲 線 をFig.2に 示 す.60Gy 未 満 で は す べ て6か 月 以 内 に 死 亡 し て お り,60Gy 以 上 の 例 で は,1年,3年,5年 45.8%,16.7%,8.3%で 生 存 率 は そ れ ぞ れ, あ っ た. 以 上 の 剖 検 症 例 の 剖 検 所 見 を,原 リ ン パ 節 転 移,遠 発 巣 の 状 態, 隔 臓 器 転 移 に つ い て 検 討 し た. 食 道 癌 原 発 巣 に つ い て は,照 し た.有 意 差 は,カ 重 複 癌 の 頻 度,発 子 別 に単 変 量 解 析 で検 討 に つ い て,Table 2に 示 す.局 得 ら れ て お り,生 隔転移の状態 所 制 御 は,10例 p<0.01(cox-mantel) 存 期 間3か 月 以 内:0例, 以 上:5例(45%)で あ 存 期 間 が3か 月 を 越 え た 症 例 で は,29例 中10例(34%)で 中,転 果 ン パ 節 転 移,遠 1年 以 内:5例(28%),1年 例 で,死 た, 生 部 位 に つ い て も検 討 し た. 食 道 癌 原 発 巣,リ っ た.生 time and Stage7). 所制御 に イ 二 乗 検 定 で 検 定 し た.ま 結 (25%)で Survival 射 線 量 と 局 所 制 御, 生 存 期 間 と の 関 係 に つ い て 検 討 し た.局 及 ぼ す 因 子 に つ い て,因 Fig.1 局 所 制 御 さ れ て い た.こ の10例 移 も な く完 全 に 治 癒 状 態 で あ っ た も の は4 因 は 心 筋 梗 塞1例,肺 道 潰 瘍 か ら の 出 血1例,他 で あ っ た.局 動 脈 血 栓 症1例,食 癌 死(重 Local tumor Lymph node metastases Distant metastases Survival curves according 複 食 道 癌)1例 所 に 腫 瘍 の 残 存 が あ り,遠 隔転 移 が Table 2. Local control, Local: LN: DM: Fig. 2 lymph node metastases, distant metastases to total radiation dose.
4 Duration between start of radiotherapy and autopsy Fig. 3 Autopsy findings according to survival time and total radiation dose. 65, 145: A patient who survived 65 months, 145 months, respectively. Table 3. Local control rate according to various factors
5 Table 4. Site and frequency of distant metastases Distant metastases 27 (68%)
6 Table 5. Previous reports *External Irradiation **High-Dose-Rate Intracavitary Irradiation
7 6) YAMAKAWA, M., SHIOJIMA, K., NIIBE, H., et al.: Radiation therapy for esophageal cancer in patients over 80 years old. Int. J. Radiat. Oncol. Biol. Phys. 30 (5): , ) Mandard, A. M., Chasle, J., Marnay, J., et al.: Autopsy findings in 111 cases of esophageal cancer. Cancer 48: , ) Anderson, L. L. and Lad, T. E.: Autopsy findings in squamous-cell carcinoma of the esophagus. Cancer 50: , ) Bosch, A., Frias, Z., Caldwell, W. L., et al.: Autopsy findings in carcinoma of the esophagus. Acta Radiol. Oncol. 18: , ) YAMADA, S., KAKUTO, Y., SAKAMOTO, K., et al.: An analysis of autopsied esophageal carcinomas treated with irradiation. J. Jpn. Soc. Ther. Radiol. Oncol. 6: 21-27, 1994.
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