化学放射線療法後に原発腫瘍とリンパ節転移に石灰化をきたした頚部食道癌の1例

Abstract

A 68-year-old woman with neck swelling and dysphagia presented at our hospital in February of 2002. In CT findings, a tumor invading the trachea and cervical lymph node metastasis (LN met) were found. No distant metastasis was observed. Therefore, we diagnosed cervical esophageal cancer (T4N3MO: stage IVa) clinically, and performed chemoradiotherapy concurrently. Radiotherapy was performed by a 4 MV linear accelerator, at a total dose of 60 Gy with a fraction of 2 Gy per day. Chemotherapy was administered as 2 cycles of cisplatin (CDDP) at 6 mg/m^2/day and 5-fluorouracil (5-Fu) at 300 mg/m^2/day (day 1-5, 8-12). After these treatments, the tumors reduced markedly and calcifications could be detected in the esophageal tumor and LN mets in CT. However, a few months later, mediastinal LN met was found, so we again performed chemoradiotherapy. Radiotherapy was performed by a 10 MV linear accelerator, at a total dose of 30 Gy with a fraction of 2 Gy per day. Chemotherapy was administered as 1 cycle of CDDP at 10 mg/day and 5～Fu at 500 mg/day (day 1-5, 8-12). After this treatment, additional chemotherapy was administered as 1 cycle of nedaplatin at 10 mg/day and 5-Fu at 500 mg/day (day 1-5, 8-12). About 10 months after the first treatment, the primary tumor grew again and the dysphagia worsened. Finally, the patient died of hemorrage due to the local tumor. We report here a rare case of calcification in presumed esophageal cancer after radiotherapy. This case suggests that the tumor calcification is a marked tumor response after chemoradiotherapy.