表在型食道癌に対するレーザー内視鏡治療の効果判定について

Abstract

Endoscopic mucosal resection (ER) and laser therapy are used against superficial esophageal cancer as endoscopic treatment. The ER is thought to be one of radical treatment for superficial esophageal cancer without lymph node or distant metastasis. But for the inoperable patients because of severe complications, ER is not only used, but also laser therapy is used. In this study, we examined about the effectiveness of laser therapy for superficial esophageal cancer and the way of follow-up after the therapy.From 1982 to 1992 at National Cancer Center Hospital, 13 patients with 14 lesions of superficial esophageal cancer were treated by laser endoscopy. The mean age of these was 73.8 years (range 62-87) and all patients had no indication for surgical operation reasons for severe complications, malignancies of other organs and refusal of surgery. The sex ratio was 12 (male/female: 12/1). Macroscopically, 1 lesion was 0-I+IIc type, II lesions were 0-IIc type and 2 lesions were 0-IIc+IIb type. About the size, 3 lesions were less than 20mm, 8 lesions were 21-40mm, 2 lesions were 41-60mm and 1 lesion was more than 61mm. Two kinds of methods as laser therapy were performed; one was photodynamic therapy (PDT: hematoporphyrin derivative+argon-dye laser) and the other Nd: YAG laser using a balloon. This balloon method was the way using a latex balloon filled with distilled water to keep the good position for laser irradiation. Nd: YAG laser was irradiated through its balloon and distilled water. Six lesions were treated by PDT (polypectomy and/or radiation was added to 3 lesions) and 8 lesions by the balloon method (radiation was added to one lesion).In 13 lesions out of 14, cancer cells disappeared after therapy. But the residue of cancer was revealed in one lesion that was wide 0-IIc+IIb type cancer (50mm in size) treated by PDT. In 4 out of 9 lesions followed up for more than a year after therapy, the recurrence of cancer was detected (PDT: 1 lesion, Nd: YAG laser: 3 lesions). These 4 recurrent lesions were found 6, 6, 7 and 12 months after treatment, respectively. These lesions were retreated by laser therapy and 3 lesions were free from cancer for more than 1 year. In one patient, the recurrence was detected again 27 months after 2nd laser therapy. And in another patient, new lesion with superficial esophageal cancer was detected by follow-up study and treated by laser endoscopic therapy. There was no lesion that progressed to the advanced cancer by follow-up and there were no patients who died of esophageal cancer expect for 6 patients died of the other diseases.In summary, it was thought that frequent follow-up, especially for a year after laser therapy, and long follow-up by endoscopy should be performed for check-up of local recurrence or the new lesions.