Medical oncology T4N4M1 I 1T4 T4 T4 T4 1 T4 down-staging T4 40Gy 1 2820 R0 down-staging R0 2 T440Gy 20Gy 3 T460Gy 4 T4 down-staging T4 43
5 1511 R0 T4 1 T436Gy 6 30 18 R0 T4 1 11 3 R0 Salvage T4 Lerut T3-4 Locally advanced 36-40Gy 7 T4 61 T414 24 CR down-staging Stahl Locally advanced 40Gy 65Gy 8 T4172 29Locally advanced T4 T4 downstaging 2 T4 full-dose Locally advanced 9 T4 M1LYM 10 CR 33 3 23 T4 M1LYM CR T350 T425 Crosby T466 M1LYM T4 11 JCOG T4 M1LYM 64.4 12 68.3CR 152 31.5 13 5FU 14 T4 CR 32T4M0 227 JCOG Phase II 15 T4 44
200618 5 14 3 CR 10 5 2 14 2N4 N4 Medical oncologist UICC TNM M1 1 3 16 5 20 17 3 2 Celiac axis TNM M1 M1a Celiac axis lymphadenopathy M.D. Anderson EUS 18 Marsman EUS 19 Medical oncologist 3 5 4 178 0 20 3IM T N M 21 15.3 T1IM 5 11.9 22 9 45
23 II Salvage 1Salvage Stage I 24 25 16 T2 Salvage Salvage 26 2004 58 salvage surgery Salvage 50Gy 50Gy Salvage 44Gy 3070Gy 4 Salvage 27 T1-T2 322 Salvage 1 41 28 T3-T423 5 Salvage 217-19 29 11 Salvage 30 50 30.8 6 Salvage 31 2 2 2 Salvage 5 Salvage 4 32 509 Salvage 33 Salvage Salvage 19982003 259Stage I 130 CR 9532 Salvage 2724 1037104 7 7 Salvage Stage IIIII 101 1 CR 6528 Salvage 232313 5749 8 16 Salvage Stage IV 28 CR 32 CR 4 Salvage Salvage 3 6 4 CR Salvage 2 Stage 46
200618 図 1 StageI, I の治療効果 図 2 Chemoradiotherapy の生存曲線 47
Salvage Salvage Salvage 2Salvage Cleveland Clinic 5.945Gy 15.7 34 Siewert 35 36 ECOG 60Gy 16 37 38 50Gy MD Swisher 13 Salvage 39 Salvage 15 Medical oncologist 60Gy Salvage Salvage 19972004 Salvage 58 185Salvage 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
200618 図 3 食道切除術後生存曲線 2 Salvage 3 Salvage 10 Salvage 3Salvage 40 41 Salvage 50Gy Salvage 2745Gy 28 42 Salvage 2 1 3 Salvage T3 49
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