Abstract
BackgroundRecurrences after radical esophagectomy are common. The prognosis for recurrent esophageal cancer is generally poor. Recurrences usually occur between 1 and 3 years of surgery, with the duration of median survival after recurrence ranging from 5 to 10 months. The number of sites and involved organs vary among patients. Consequently, a standard therapeutic strategy has not been established, and the role of surgery in the management of recurrence is unclear.Case presentationA 67-year-old man presented with dysphagia 6 months previously and was diagnosed with esophageal squamous cell carcinoma (ESCC) in the upper thoracic region (T2M0M0, stage IB), for which he underwent thoracoscopy-assisted esophagectomy and lymphadenectomy. Adjuvant chemotherapy was not prescribed. Three years after the operation, he developed a solitary metastasis in the left lung, requiring segmentectomy followed by chemotherapy with combined cisplatin (CDDP) and 5-fluorouracil (5-FU). The following year, a metastatic lesion was recognized in the right lung, invading the chest wall, for which he underwent partial lobectomy with local chest wall resection. Multiple mediastinal and abdominal lymph node (LN) metastases were detected in the right lung a year later, which necessitated chemoradiation to a dose of 50.4 Gy with concomitant CDDP and 5-FU. Post-treatment computed tomography (CT) showed a good response. Positron emission tomography (PET)-CT revealed a reduction in the metastatic LNs with no fluoro-deoxy-glucose (FDG) uptake. The following year, metastases were detected in the left cervical LNs. Owing to the limited extent of metastases, resection was followed by chemoradiation to a dose of 50 Gy with CDDP and 5-FU. The following year, metastases were detected in the mediastinal LNs; chemotherapy was administered with nedaplatin and docetaxel. The follow-up CT and PET-CT demonstrated complete disappearance of the tumor, and the patient is currently surviving without recurrence for 11 years from the first curative operation.ConclusionsThis case demonstrates that aggressive multidisciplinary treatment including surgery and radiation to achieve local control could be a meaningful treatment strategy in cases with limited and slowly occurring recurrences.
Highlights
This case demonstrates that aggressive multidisciplinary treatment including surgery and radiation to achieve local control could be a meaningful treatment strategy in cases with limited and slowly occurring recurrences
In terms of the patterns of recurrence, locoregional, hematogenous, and mixed types were seen in 54%, 36%, and 10% of the patients, respectively [8], which reflected the trends in previous reports [9,10,11,12,13]
Suzuki et al reported on the successful management of recurrent esophageal cancer in a patient with recurrence in the para-aorta lymph node (LN) and liver [26]; the patient received chemoradiotherapy and chemotherapy, both systemically and via hepatic arterial infusions
Summary
We present a case of long-term survival with multidisciplinary treatment for multiple sequential recurrences in ESCC after curative esophagectomy. Despite the poor prognosis of recurrent esophageal cancer, this case demonstrates that multidisciplinary management, including aggressive local therapies, can be effective in cases with localized recurrences, appearing gradually. Cumulative accounts of similar cases, with detailed analyses, are necessary to establish the optimal treatment strategy for recurrences in ESCC. Abbreviations 5-FU: 5-Fluorouracil; CDDP: Cisplatin; CT: Computed tomography; ESCC: Esophageal squamous cell carcinoma; FDG: Fluoro-deoxy-glucose; LN: Lymph node; PET-CT: Positron emission tomography; SCC: Squamous cell carcinoma
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