我が国における悪性胸膜中皮腫に対する集学的治療の現状

Current Status of Multi-modality Treatment for Malignant Pleural Mesothelioma in Japan

長谷川 誠紀

田中 文啓

岡田 守人

中野 孝司

肺癌

背景.平成18年度文部科学省科学技術振興調整費「アスベスト関連疾患への総括的取り組み」の一環として,我が国における悪性胸膜中皮腫に対する集学的治療の現状を調査した.対象と方法.2002年1月?2006年12月の5年間に悪性胸膜中皮腫に対して胸膜肺全摘術(EPP)を完遂した症例のみを対象とした.アンケートは本プロトコールへの参加表明施設とJCOG参加施設の計69施設に送付し,うち61施設から返答を得た.結果.対象5年間にEPPを完遂した症例は計171例,男性/女性154例/17例,右/左91例/80例,年齢14?78歳,平均59歳.手術後30日以内の死亡は1例(間質性肺炎),在院死は6例(腫瘍再発4例.MRSA膿胸1例,肺梗塞1例).シスプラチンを含む術前化学療法を行った症例は38例,うち12例ではシスプラチンを含む術前化学療法と術後片側全胸郭照射を完遂した.術後生存期間の中央値は23ヶ月であった.結論.我が国の悪性胸腹中皮腫に対するEPPは症例数の増加と安全性の改善が確認された.しかし,集学的治療のfeasibilityに関しては現時点でなお十分なデータが存在しない.

Background. We investigated the current status of multi-modality treatment for malignant pleural mesothelioma in Japan as part of the campaign entitled "Comprehensive Strategy Against Asbestos-related Diseases" , which was funded by the 2006 Special Coordination Fund for Promoting Science and Technology from the Japan Science and Technology Agency.
Methods. We evaluated cases of extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma between January 2002 and December 2006. A questionnaire was sent to a total of 69 institutions, and was returned by 61 of them.
Results. A total of 171 patients underwent EPP for malignant pleural mesothelioma during the study period. They consisted of 154 males and 17 females, and the age ranged between 14 and 78 with the average of 59. The side of EPP was on the right in 91 and on the left in 80 cases. One postoperative death due to interstitial pneumonia and 6 in-hospital deaths due to tumor recurrence (n=4), MRSA empyema (n=1), and pulmonary infarction (n=1) were noted. Preoperative chemotherapy with cisplatin was given in 38 patients, and 12 out of 38 underwent postoperative hemithorax radiation therapy. The median survival was 23 months.
Conclusions. The present study showed an increase of cases and also improvement of surgical mortality of EPP for malignant pleural mesothelioma in comparison with former studies. However, we still do not have clinical evidence regarding the feasibility of multi-modality treatment for malignant pleural mesothelioma.

悪性胸腹中皮腫

胸膜肺全摘術

化学療法

放射線療法

集学的

Malignant pleural mesothelioma

Extrapleural pneumonectomy

Chemotherapy

Radiation therapy

医学 [ 490 ]

日本語

日本肺癌学会

日本肺癌学会

本文データは学協会の許諾に基づきCiNiiから複製したものである

[ISSN] 0386-9628

[NCID] AN00203978

[NAID] 110006668145 ～の異版である