消化器 - kkr-smc.com

1 157 I 1 EMR 3 1 2 1 I III 3 1 CT X CT X StageIIIIEMRsmmIInon T4IV A 1 T4 SurgeryRTCRT EMR endoscopic mucosal resectionRT radiation therapyCRT chemoradiation therapy 158 PET CT GTV GTV CT GTV GTV X CT MRI 5 GTV 2 GTV #106 CTVCTV1 GTV 2 4 GTV 2 CTV1 10 N1 10 N2 CTV1 Ce-Ut105 ,101 , 106 rec 104 , 106-tbL , 107 , 108 , 109 101,104,105,106, 107,108Mt108 , 106rec 101.

2 105 , 106tbL , 107 , 109 , 110 , 1 ,2 , 3 , 101,104,105,106, 107,108,110,1,2Lt-Ae110 , 1 , 2 106rec , 107 , 108 , 109 , 111 , 112 , 3 , 7 , 20 105,106,107, 108,110,1,2,3,7,9 159 CTV 2 Mt CTV2 2 GTV PTVPTV1 CTV1 1 1 2 PTV X PTV PTV 2 CTV2 1 1 2 PTV 2 X X CT X CT X 3 PTV1 1

3 2 40Gy 46Gy PTV2 30 45 Ce 6 10MV X 1604 50Gy 25 28 5 6 3 60Gy 30 6 8 60 70Gy 30 35 6 7 4 JASTRO 5 3 1 1 4 Gy 1 6 Gy 5 5 5 FU 1 2 4 161 6 5 FU 15 20 7 5 4 JASTRO 5 EXRTICRTT otal dosem1 m2 mucosal cancer EXRT alone60 66Gy/30 33fx/6 60 66 GyHigh dose rate ICRT alone 28 32Gy/7 8fx/2 times a week28 32Gy 35Gy/13 14fx/4 times a week35 Gym3 sm3 EMR residual tumor EMR complete resection EXRT alone60 70Gy/conventional fractionation or accelerated 60 70

4 GyEXRT high dose rate ICRT50 60Gy/25 30fx/5 6 w8 12Gy/3 4 fx/1 4times a week58 72 GyEXRT low dose rate ICRT60Gy/30fx/ 6 w12Gy/3fx/ 2 times a week72 Gyany of the treatment aboveEXRT alone50Gy/conventional fractionation 50Gy 3 JASTRO EXRT external beam radiation therapy ICRT intra-cavitary radiation therapy w week fx fraction 162 5 62 81 5 5 42 64 5 II III T4 3 40 50% T4/M1/LYM 3 20% 5 1 2 T4 7 8 FDG 9 10 10 6 1 Fiorica F, Di Bona D, Schepis F, et al.

5 Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53: 925-930, Mizowaki T, Nishimura Y, Shimada Y, et al. Optimal size criteria of malignant lymph nodes in the treatment planning of radiotherapy for esophageal cancer: evaluation by computed tomography and magnetic resonance imaging. Int J Radiat Oncol Biol Phys 36: 1091-1098, Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 Radiation Therapy Oncology Group 94-05 phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20 : 1167-1174, 2002. 1634 Shi XH, Yao W, Liu T. Late course accelerated fractionation in radiotherapy of esophageal carcinoma. Radiother Oncol 51: 21-26.

6 12: 169-176, Wong R, Malthaner R. Combined chemotherapy and radiotherapy without surgery compared with radiotherapy alone in localized carcinoma of the esophagus Cochrane Review . In : The Cochrane Library, 4, 2001. Oxford: Update Yorozu A, Dokiya T, Oki Y, et al. Curative radiotherapy with high-dose-rate brachy-therapy boost for localized esophageal carcinoma: dose-effect relationship of brachy-therapy with the balloon type applicator system. Radiother Oncol 51 : 133-139, Ishikura S, Nihei K, Ohtsu A, et al. Long-term toxicity after definitive chemoradio therapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 21: 2697-2702, Jingu K, Kaneta T, Nemoto K, et al. The utility of 18 F-fluorodeoxyglucose positro nemission tomography for early diagnosis of radiation-induced myocardial damage.

7 Int J Radiat Oncol Biol Phys 66: 845-851, Nishimura Y, Nagata K, Katano S, et al. Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents : a questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Biol Phys 56: 1327-1332, . 2007 2007.