維持透析中に肺尖部胸壁浸潤癌に対して術前化学放射線療法と第 1・第 2 肋骨合併切除により根治治療を完遂しえた 1 例

Background. In patients undergoing maintenance hemodialysis, the frailty of their general condition often complicates the selection of an appropriate treatment strategy for lung cancer, particularly in advanced stages. Case. A 75-year-old man on maintenance dialysis due to nephrosclerosis was referred for evaluation of an abnormal chest shadow. The image revealed a 67-mm mass in the left upper lobe with infiltration into the soft tissue of the first intercostal space. He was diagnosed with squamous cell carcinoma of the lung (cT3N0M0, stage IIB), with no evidence of distant metastasis. Concurrent chemoradiotherapy with carboplatin and paclitaxel (40 Gy in 20 fr) was administered. The therapeutic response was classified as stable disease, and the patient subsequently underwent left upper lobectomy with combined resection of the first and second ribs. A pathological examination showed a major pathological response with 90% tumor necrosis, and complete resection was achieved. Postoperatively, the patient developed pneumonia, which resolved with antibiotic therapy. No recurrence has been observed; however, at 8 months postoperatively, the patient was transferred to a long-term care facility due to a decline in his overall condition following pneumonia. Conclusion. This case demonstrates that a multimodal therapy, including chemoradiotherapy followed by extended surgery, can be a feasible option for patients on maintenance dialysis. Although postoperative complications occurred, local tumor control was achieved. Given the limited physiological reserve in such patients, the treatment of advanced lung cancer involves considerable physical and psychological challenges, underscoring the need for comprehensive supportive care and meticulous perioperative management.