A Case of Esophageal Cancer with Lymph Node Recurrence Three Times and Secondary Cancer after Definitive Chemoradiotherapy

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  • SAKATOKU Yayoi
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • FUKAYA Masahide
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • MIYATA Kazushi
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • TAKAHASHI Takamasa
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • NAGINO Masato
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine

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Other Title
  • 根治的化学放射線療法後3度の再発と二次原発癌をきたした食道癌の1例
  • 症例 根治的化学放射線療法後3度の再発と二次原発癌をきたした食道癌の1例
  • ショウレイ コンジテキ カガク ホウシャセン リョウホウ ゴ 3ド ノ サイハツ ト ニジ ゲンパツガン オ キタシタ ショクドウ ガン ノ 1レイ

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Abstract

A 50-year-old woman was diagnosed with unresectable advanced middle thoracic esophageal cancer with lymph node metastases involving the trachea in July 2008. After definitive chemoradiotherapy (dCRT) with cisplatin (CDDP) / 5-fluorouracil (5-FU) and 60 Gy irradiation and additional 2 courses of CDDP / 5-FU were performed, complete response (CR) was obtained. Around half year after the treatment, positron emission tomography-computed tomography showed para-aortic lymph node (PAN) and supraclavicular lymph node (SCN) metastases. Five courses of CDDP / 5-FU and 3 courses of 5-FU / nedaplatin (CDGP) were performed. CR was achieved for PAN but not for SCN, which was judged as stable disease (SD). Since no other lesions were identified, she underwent salvage lymphadenectomy in July 2010. Seven months after the operation, paraesophageal and peri-gastric lymph nodes metastases were detected. After 5 courses of 5-FU / CDGP, the metastatic lymph nodes disappeared. However, relapse of paraesophageal lymph node metastasis and secondary primary esophageal cancer at 23 cm from the incisor teeth developed in February 2012. As R0 resection could be expected, salvage esophagectomy by laparotomy-right thoracotomy approach was performed in March 2012. The patient is now alive without recurrence for 3 years and 7 months after the salvage esophagectomy (or 7 years and 3 months after dCRT).

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