当科における耐術能不良な食道がん症例に対する集学的治療の現状 ： 特に高齢者治療の観点から

Abstract

In this study, we examined the features of patients with advanced unresectable squamous cell carcinoma of the thoracic esophagus in our hospital and validated our strategy of intensive treatment. The average age of our patients was higher than those reported by other facilities and our elderly patients had various kinds of complications. We basically performed either chemoradiation (CRT) or radiation (RT) therapy for these patients with unresectable esophageal cancer. Median survival time of the intensively treated patients with CRT/RT was almost twice longer than those with only best supportive care. An improved food intake was noted in two-thirds of our patients after CRT/RT because of tumor shrinkage. For the less collapsing ratio of CRT, we chose concurrent CRT with low-dose cisplatin (CDDP) plus continuous infusion of 5-fluorouracil (LDFP) especially to elderly patients. Actually, in our hospital, the incidence of hematotoxicity by LDFP was distinctly lower compared with the standard-dose CDDP plus continuous infusion of 5-fluorouracil (SDFP). Additionally, new combination chemoradiotherapy with cisdiammine-glycolate platinum (Nedaplatin) and 5-fluorouracil was given to patients with advanced esophageal cancer and other organ metastasis. Nedaplatin has been known to be less toxic for kidney and digestive organs and to show much stronger antitumor activity compared to CDDP in patients with esophageal cancer. Our overall CRT/RT outcome should be acceptable, if taking patients' ages and their various complications into consideration. We recognized the necessity of making an appropriate medical decision in each elderly patient receiving intensive treatment against unresectable advanced esophageal cancer and of managing adverse effects of CRT/RT promptly for attaining good prognosis and high quality of life.