臨床外科73巻5号

2018年05月発行

特集 縦隔を覗き，さらにくり抜く—これからの食道・胃外科手術 食道胃接合部癌に対する手術

食道胃接合部癌に対する集学的治療の将来展望—国内外のエビデンスより

著者： 山田貴允¹ 林勉¹ 尾形高士¹ 吉川貴己¹

所属機関： ¹神奈川県立がんセンター消化器外科

ページ範囲：P.566 - P.571

【ポイント】
◆食道胃接合部癌のみを対象とした試験は少なく，結果の解釈にはサブセット解析などにも注意が必要である．
◆多くの臨床試験で補助化学（放射線）療法の有用性が示されていて，局所進行食道胃接合部癌には集学的治療が非常に重要である．
◆さらに分子標的薬や免疫チェックポイント阻害薬を用いた試験が現在進行しており，その結果が注目される．

参考文献

1）Sasako M, Sano T, Yamamoto S, et al：Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia：a randomised controlled trial. Lancet Oncol 7：644-651, 2006

2）Hulscher JB, van Sandick JW, de Boer AG, et al：Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347：1662-1669, 2002

3）Sakuramoto S, Sasako M, Yamaguchi T, et al：Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357：1810-1820, 2007

4）Bang YJ, Kim YW, Yang HK, et al：Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy（CLASSIC）：a phase 3 open-label, randomised controlled trial. Lancet 379：315-321, 2012

5）Macdonald JS, Smalley SR, Benedetti J, et al：Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345：725-730, 2001

6）Fuchs CS, Niedzwiecki D, Mamon HJ, et al：Adjuvant chemoradiotherapy with epirubicin, cisplatin, and fluorouracil compared with adjuvant chemoradiotherapy with fluorouracil and leucovorin after curative resection of gastric cancer：results from CALGB 80101（Alliance）. J Clin Oncol 35：3671-3677, 2017

7）Lee J, Lim DH, Kim S, et al：Phase Ⅲ trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection：the ARTIST trial. J Clin Oncol 30：268-273, 2012.

8）Kelsen DP, Ginsberg R, Pajak TF, et al：Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339：1979-1984, 1998

9）Schuhmacher C, Gretschel S, Lordick F, et al：Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia：European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 28：5210-5218, 2010

10）Medical Research Council Oesophageal Cancer Working Group：Surgical resection with or without preoperative chemotherapy in oesophageal cancer：a randomised controlled trial. Lancet 359：1727-1733, 2002

11）Alderson D, Cunningham D, Nankivell M, et al：Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma（UK MRC OE05）：an open-label, randomised phase 3 trial. Lancet Oncol 18：1249-1260, 2017

12）Tepper J, Krasna MJ, Niedzwiecki D, et al：Phase Ⅲ trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer：CALGB 9781. J Clin Oncol 26：1086-1092, 2008

13）van Hagen P, Hulshof MC, van Lanschot JJ, et al：Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366：2074-2084, 2012

14）Stahl M, Walz MK, Riera-Knorrenschild J, et al：Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction（POET）：Long-term results of a controlled randomised trial. Eur J Cancer 81：183-190, 2017

15）Cunningham D, Allum WH, Stenning SP, et al：Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355：11-20, 2006

16）Cunningham D, Stenning SP, Smyth EC, et al：Peri-operative chemotherapy with or without bevacizumab in operable oesophagogastric adenocarcinoma（UK Medical Research Council ST03）：primary analysis results of a multicentre, open-label, randomised phase 2-3 trial. Lancet Oncol 18：357-370, 2017

17）Ychou M, Boige V, Pignon JP, et al：Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma：an FNCLCC and FFCD multicenter phase Ⅲ trial. J Clin Oncol 29：1715-1721, 2011

18）Cooper JS, Guo MD, Herskovic A, et al：Chemoradiotherapy of locally advanced esophageal cancer：long-term follow-up of a prospective randomized trial（RTOG 85-01）. Radiation Therapy Oncology Group. JAMA 281：1623-1627, 1999

19）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