A case of metachronous double cancer of the esophagus and stomach.

われわれは異時性に胃癌と食道癌を重複した1例を経験した.順次的に放射線化学療法を行い比較的長期の病勢コントロールが得られたので文献的考察を加えて報告する.症例は69歳,男性.2009年11月心窩部痛を主訴に受診した.上部消化管内視鏡検査で前庭部に3型の腫瘍を指摘され生検で腺癌であった.幽門側胃切除を施行し,術後DTX(docetaxel)+S-1療法を5コース投与した.術後1年目の上部消化管内視鏡検査で胸部中部食道に凹凸不整な粘膜を認め,生検で扁平上皮癌と診断された.開腹すると広汎な腹膜播種を認め迅速病理で胃癌からの腺癌の播種性転移であった.CDDP+S-1を6コース投与し奏効した.その4ヵ月後に食道癌の再燃を認め,CDDP+S-1を4コース追加したが増悪を認めたため順次的に食道癌に対して放射線照射を追加し,腫瘍およびリンパ節転移は縮小した.その2ヵ月後に食道腫瘍の再燃が疑われたためDTX+CDGP療法を開始して現在,経過観察中である.

We experienced a case of metachronous double cancer of the esophagus and stomach. This patient showed good prognosis with sequential adjuvant chemoradiation therapy. A 69-year-old man with a chief complaint of epigastralgia was admitted to our hospital in November 2009. Upper gastrointestinal endoscopic examination showed type 3 gastric cancer in the antrum. Pathological examination indicated that the tumor was an adenocarcinoma. After distal partial gastrectomy was performed, adjuvant chemotherapy with docetaxel and S-1 were administered. One year after surgery, upper endoscopic examination revealed a thoracic type 0-II esophageal tumor in the middle esophagus. Pathological examination indicated that this tumor was a squamous cell carcinoma. Laparotomy showed wide dissemination, and the tumor was diagnosed as metastasis from adenocarcinoma on the basis of intraoperative rapid pathological examination. Six courses of chemotherapy with CDDP and S-1 were effective, but 4 months later, the esophageal cancer recurred. Therefore, 4 courses of the same chemotherapy regimen were administered. The patient showed disease progression. Sequential radiation therapy for the esophageal cancer successfully reduced the size of the main tumor and metastatic lymph nodes. Two months later, endoscopic examination indicated recurrence of the esophageal cancer. Therefore, we started treatment with combined therapy with DTX and CDGP.

食道癌

胃癌

異時性重複癌

腹膜播種

化学療法