胃と腸42巻8号

2007年07月発行

今月の主題 胃MALTリンパ腫―除菌無効例の特徴と治療戦略 主題

多施設共同研究の成績からみた除菌無効胃MALTリンパ腫の特徴と治療

著者： 門脇重憲¹ 土井俊彦¹ 藤島佳美¹ 大津敦¹ 吉田茂昭²

所属機関： ¹国立がんセンター東病院消化管内科/内視鏡部 ²国立がんセンター東病院

ページ範囲：P.1261 - P.1266

要旨　限局期胃MALTリンパ腫に対してHelicobacter pylori（H. pylori）除菌治療は，第一選択治療として確立されつつあり，50～95％の完全寛解をもたらす．H. pylori陰性例，深部浸潤例，隆起型，t(11;18)転座陽性例，high-grade成分の存在などが除菌無効例の特徴とされているが，無効例に対する二次治療としての放射線療法，化学療法などの有用性も多数報告されている．最近になり，海外で除菌治療についての多施設共同試験の報告もいくつかなされたが，二次治療まで含めた胃MALTリンパ腫の治療体系においてのエビデンスレベルは低い．また，除菌無効例の取り扱い，二次治療の方法と時期，high-grade成分の取り扱い，二次治療としての放射線療法の照射法など不明な点も多い．現在，海外でもいくつかの臨床試験が進行もしくは計画されており，本邦の臨床試験の結果も含めて，その結果に期待したい．

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