Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report

Figure 1 Endoscopic findings. A: Initial endoscopic findings detected type 2 tumor located on the middle part of the esophagus; B: After 3 courses of induction docetaxel, cisplatin and fluorouracil chemotherapy. Primary tumor volume decreased; C: After subsequent definitive chemoradiotherapy. Esophagogastroduodenoscopy findings showed a prominent reduction of the primary tumor, with ulceration; D: Fourteen months after additional 2 courses cisplatin plus 5fluorouracil chemotherapy. Primary lesion maintained clinically and pathologically complete response.

Figure 2 Computed tomography findings showing level of left bronchus. A: Initial computed tomography findings suspected to invasion to the left bronchus; B: After 3 courses of induction docetaxel, cisplatin and fluorouracil. Shrinkage of the tumor size was recognized but invasion of the left bronchus was still suspected; C: After subsequent definitive chemoradiotherapy. Primary tumor volume decreased; D: Fourteen months after additional 2 courses of cisplatin plus 5fluorouracil chemotherapy. Primary tumor has maintained shrinkage.

Figure 3 Computerized tomography findings showing level of aorta. A: Initial computed tomography findings suspected to 90° of direct contact with the aorta, which defined as invasion to the aorta; B: After 3 courses of induction docetaxel, cisplatin and fluorouracil. Shrinkage of the tumor size was recognized but invasion of the aorta was still suspected; C: After subsequent definitive chemoradiotherapy. Primary tumor volume decreased; D: Fourteen months after additional 2 courses of cisplatin plus 5fluorouracil chemotherapy. Primary tumor has maintained shrinkage.

Figure 4 Computed tomography findings showing #106recR lymph node. A: Initial computed tomography findings suspected swollen lymph node (10.16 mm × 8.02 mm); B: After 3 courses of induction docetaxel, cisplatin and fluorouracil. Slightly shrinkage of the lymph node size (8.01 mm × 6.69 mm) was recognized; C: After subsequent definitive chemoradiotherapy. #106recR lymph node did not change in size (8.31 mm × 7.59 mm); D: After additional 2 courses of cisplatin plus 5fluorouracil chemotherapy. #106recR lymph node could not be detected (Orange arrow; 106recR lymph node).

Figure 5 Chemoradiation planning. A: Swollen lymph node (#106recR) was designated as gross tumor volume node; B and C: The clinical target volume included the gross tumor volume and a craniocaudal margin of 2.4 cm around the primary tumor.

Figure 6 Pathological examination, biopsy from primary lesion. A: Initial biopsy from primary tumor revealed squamous cell carcinoma (× 10). A proliferation of large atypical cells with swollen deep-stained nuclei was observed. A squamous cell carcinoma with a tendency toward keratinization, intercellular bridges, necrosis, and large atypical cells with bizarre nuclei were evident; B: Fourteen months after additional 2 courses of cisplatin plus 5fluorouracil chemotherapy, primary lesion has maintained pathologically negative for cancer (× 20). There is a small infiltration of inflammatory cells, but no obvious evidence of malignant cells.