サルベージＣＲＴ

食道癌が手術のときに取り切れなくて、気管に一部が

残ってしまったときに、あとからケモラジはどうなんでしょう？

のお答え、追記です。

↓うちの施設の成績です。

Dis Esophagus. 2015 Jul;28(5):460-7. doi: 10.1111/dote.12217. Epub 2014 Apr 9.

Salvage chemoradiotherapy for locally advanced esophageal carcinomas.

Nakajima Y1, Kawada K1, Tokairin Y1, Miyawaki Y1, Okada T1, Ryotokuji T1, Fujiwara N1, Saito K1, Fujiwara H1, Ogo T1, Okuda M1, Nagai K1, Miyake S2, Kawano T1.

Author information

Abstract

'Salvage chemoradiotherapy (CRT)' was introduced in 2005 to treat thoracic esophageal carcinomas deemed unresectable based on the intraoperative findings. The therapeutic concept is as follows: the surgical plan is changed to an operation that aims to achieve curability by the subsequent definitive CRT. For this purpose, the invading tumor is resected as much as possible, and systematic lymph node dissection is performed except for in the area around the bilateral recurrent nerves. The definitive CRT should be started as soon as possible and should be performed as planned. We hypothesized that this treatment would be feasible and provide good clinical effects. We herein verified this hypothesis. Twenty-seven patients who received salvage CRT were enrolled in the study, and their clinical course, therapeutic response, and prognosis were evaluated. The patients who had poor oral intake because of esophageal stenosis were able to eat solid food soon after the operation. The radiation field could be narrowed after surgery, and this might have contributed to the high rate of finishing the definitive CRT as planned. As a result, the overall response rate was 74.1%, and 48.1% of the patients had a complete response. No patient experienced fistula formation. The 1-, 3-, and 5-year overall survival rates were 66.5%, 35.2%, and 35.2%, respectively. Salvage CRT had clinical benefits, such as the fact that patients became able to have oral intake, that fistula formation could be prevented, that the adverse events associated with the definitive CRT could be reduced, and that prognosis of the patients was satisfactory. Although the rate of recurrent nerve paralysis was relatively high even after the suspension of aggressive bilateral recurrent nerve lymph node dissection, and the rate of the progressive disease after the definitive CRT was high, salvage CRT appears to provide some advantages for the patients who would otherwise not have other treatment options following a non-curative and residual operation

たった27例、「前向き研究」ではありませんが、手術で癌が残ってしまった方にケモラジを追加することのメリット。

1）ご飯が食べられることが確保できる　家に帰る道がつく。

2）瘻孔形成や大出血をとりあえず回避できる。

3）まだ治療としてＣＲＴが残ってる。　

4）照射範囲を絞り込みができる　余計な照射をしなくてすむ。

小さく残ったところに照射することでＣＲ48％で5年生存も35％だから悪くない。もちろん

いい症例を選んで手術をしているのでバイアスはありますけども。。。

とれるかとれないか分からなくても手術を選択する意義はある。

残ってしまってもまだまだあきらめないで！

ぽちっとな