Abstract
BackgroundRadical esophagectomy for esophageal squamous cell carcinoma has improved survival, but the rate of recurrence is high. Patients of recurrent esophageal squamous cell carcinoma after failure of chemotherapy have a poor prognosis. We herein report the achievement of long-term survival after definitive proton beam therapy for oligorecurrent esophageal squamous cell carcinoma after failure of chemotherapy.Case presentationA 60-year-old Japanese man was diagnosed as having squamous cell carcinoma of the lower thoracic esophagus (cT2N0M0, stage IIA). He underwent two courses of neoadjuvant chemotherapy with cisplatin and 5-fluorouracil, and esophagectomy with three-field lymphadenectomy was performed. Microscopic findings after resection showed two lymph node metastases (ypT2N1M0, stage IIB). Five months after resection, a computed tomography scan revealed a solitary liver metastasis in the S4 area. He underwent three courses of chemotherapy with cisplatin and 5-fluorouracil; however, positron emission tomography revealed two lymph node metastases. Surgeons recommended second-line chemotherapy, but the patient refused chemotherapy and requested proton beam therapy. We performed proton beam therapy without chemotherapy for the liver metastasis and lymph node metastases, with total doses of 79.2 and 60 Gy relative biological effectiveness, respectively, according to the tumor location. An acute side effect of grade 1 dermatitis occurred after proton beam therapy, but there was no acute or late complication of more than grade 2. The patient remains in complete remission 5 years after treatment without surgery or chemotherapy.Discussion and conclusionsProton beam therapy exerted a curative effect on oligorecurrent esophageal squamous cell carcinoma. This is the first report on the achievement of long-term survival after definitive proton beam therapy for oligorecurrent esophageal squamous cell carcinoma.
Highlights
Radical esophagectomy for esophageal squamous cell carcinoma has improved survival, but the rate of recurrence is high
Proton beam therapy exerted a curative effect on oligorecurrent esophageal squamous cell carcinoma
This is the first report on the achievement of long-term survival after definitive proton beam therapy for oligorecurrent esophageal squamous cell carcinoma
Summary
A total irradiation dose of 60–70 Gy has been used for radiation therapy for recurrent ESCC without chemotherapy, and the 5-year overall survival rate was reported to be 11–22% [11]. Despite the fact that firstline therapy in our patient with ESCC failed, we were able to control liver metastasis and lymph node metastases due to the high dose of PBT and the biological effective advantage of PBT compared with conventional X-ray therapy. The abscopal effect is probably associated with our good local control without chemotherapy for recurrence of ESCC by PBT. This effect is known as an immune effect caused by high doses of radiation and other factors. To the best of our knowledge, there has been no study on an abscopal effect of PBT for ESCC This is an interesting case report on management of a single liver metastasis with lymph nodal disease progression in the paraaortic area.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
