Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2801-2810
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2801
Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report
Masahiro Yura, Kazuo Koyanagi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Yoshifumi Tamai, Reiko Dehari, Motohito Nakagawa
Masahiro Yura, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Motohito Nakagawa, Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
Kazuo Koyanagi, Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan
Yoshifumi Tamai, Department of Radiology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
Reiko Dehari, Department of Surgical Pathology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
Author contributions: Yura M and Koyanagi K wrote this paper; Nakagawa M reviewed the manuscript; Tamai Y planned and performed radiation therapy; Dehari R contributed to pathological diagnosis; and all other members equally contributed to medical treatment.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masahiro Yura, MD, Doctor, Surgeon, Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka-shi, Kanagawa 2540065, Japan. myura@ncc.go.jp
Received: August 27, 2020
Peer-review started: August 27, 2020
First decision: December 20, 2020
Revised: January 2, 2021
Accepted: March 5, 2021
Article in press: March 5, 2021
Published online: April 26, 2021
Abstract
BACKGROUND

Definitive chemoradiotherapy (dCRT) using cisplatin plus 5fluorouracil (CF) with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma (ESCC). Recently, induction chemotherapy has received attention as an effective treatment strategy.

CASE SUMMARY

We report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by dCRT. Initial esophagogastroduodenoscopy (EGD) detected a type 2 advanced lesion located on the middle part of the esophagus, with stenosis. Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90° of direct contact with the aorta, and upper mediastinal lymph node metastasis. Pathological findings from biopsy revealed squamous cell carcinoma. We initially performed induction chemotherapy using three courses of DCF, but the lesion was still evaluated unresectable after DCF chemotherapy. Therefore, we subsequently performed dCRT treatment (CF and radiation). After dCRT, prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD. Since the patient had some surgical risk, we performed two additional courses of CF and achieved a clinically complete response. After 14 mo from last administration of CF chemotherapy, recurrence has not been detected by computed tomography and EGD, and biopsy from the scar formation has revealed no cancer cells.

CONCLUSION

We report successful case with tumor remnants even after DCF and subsequent dCRT, for whom a complete response was finally achieved with two additional courses of CF chemotherapy. Additional CF chemotherapy could be one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery, especially for high-risk patients.

Keywords: Unresectable esophageal cancer, Induction docetaxel, cisplatin and fluorouracil, Chemoradiotherapy, Complete response, Additional chemotherapy, Case report

Core Tip: Salvage surgery after definitive chemoradiotherapy (dCRT) for T4 esophageal cancer is associated with a high incidence of surgery-related death and severe complication. In the present study, we have described the successful case of an unresectable locally advanced T4 esophageal squamous cell carcinoma treated by additional cisplatin plus 5fluorouracil chemotherapy after induction docetaxel, cisplatin and fluorouracil followed by dCRT. This case suggests that additional cisplatin plus 5fluorouracil chemotherapy could be one radical treatment option for residual esophageal squamous cell carcinoma after induction docetaxel, cisplatin and fluorouracil followed by dCRT to avoid salvage surgery, especially for high-risk patients.