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━━ Background. The incidence of radiation-associated cancer has increased with an improved survival after radiotherapy. We herein report a case of spindle cell carcinoma associated with postoperative radiotherapy for T3 lung cancer. Case. A 51-year-old man had undergone left upper lobectomy with partial parietal pleurectomy and postoperative radiotherapy to the chest wall for poorly-differentiated squamous cell carcinoma of the lung (pT3N0M0, stage IIB). No recurrence had been observed for 5 years. Thirteen years later, a mass appeared in the irradiated field and grew rapidly. Because the tumor was located mainly within the chest wall, we thought that the chest wall tumor was invading the lung. Radiation-associated sarcoma was suspected, and the chest wall resected with a partial resection of the left lower lobe. However, a histopathological analysis indicated spindle cell carcinoma. Local recurrence and multiple metastases were detected 6 months after the operation. Although chemotherapy was performed, the patient died 12 months after the operation. Conclusion.We reported a case of spindle cell carcinoma that developed 13 years after postoperative radiotherapy for T3 lung cancer. (JJLC. 2015;55:218-222) KEY WORDS━━Radiation-associated cancer, Spindle cell carcinoma, Postoperative radiotherapy for T3 lung cancer Received February 9, 2015; accepted June 13, 2015. 要旨━━背景.一次癌に対する放射線治療後の生存期 間が延長するに伴い,放射線関連の二次癌が増加傾向と なっている.我々は肺癌術後放射線治療後に発生した紡 錘細胞癌の 1例を経験したので報告する.症例.51 歳の 男性.左肺癌 扁平上皮癌 pT3(pl3)N0M0 stage IIB に対して胸壁(胸膜)合併左上葉切除を施行した.術後, 胸壁に対して放射線治療(50 Gy)を施行した.その後 5 年間の経過観察期間中には再発徴候を認めなかった.し かし,治療から 13 年後に放射線照射部位に腫瘤が出現 し,急速に増大した.腫瘤の大部分が胸壁に存在してい たため,胸壁発生の放射線誘発肉腫を疑い,胸壁腫瘍摘 出,左残存下葉部分切除を施行した.術後病理検査にて 紡錘細胞癌と診断した.術 6か月後に再発し化学療法を 開始したが,術 12 か月後に永眠された.結論.今回,我々 はT3肺癌術後に放射線治療を行い,その 13 年後に放射 線照射野に発生した紡錘細胞癌の 1例を経験した. 索引用語━━放射線誘発癌,紡錘細胞癌,T3肺癌術後 放射線治療 1独立行政法人国立病院機構近畿中央胸部疾患センター呼吸器外 科. 受付日:2015 年 2 月 9 日,採択日:2015 年 6 月 13 日. (肺癌.2015;55:218-222) 2015 The Japan Lung Cancer Society A Case of Radiation-associated Spindle Cell Carcinoma―Tomita et al Japanese Journal of Lung Cancer―Vol 55, No 4, Aug 20, 2015―www.haigan.gr.jp 219 Figure 1. A chest X-ray film in 2013 showed a 5 cm tumor with an extrapleural sign in the left upper field. はじめに 一次癌に対する放射線治療後の生存期間が延長するに 伴い,放射線照射野に発生する二次癌は増加傾向であ る.1 しかし,非小細胞肺癌放射線治療後の報告例は稀で ある.今回,我々はT3肺癌術後放射線治療 13 年後に放 射線照射野に発生した紡錘細胞癌の 1例を経験したの で,報告する.

A Case of Spindle Cell Carcinoma That Developed 13 Years After Postoperative Radiotherapy for T3 Lung Cancer