[A case of thoracic esophageal cancer with invasion of the main bronchus in which long-term survival with high quality of life was achieved through chemoradiotherapy, esophageal bypass and then additional chemotherapy].

We administered chemoradiotherapy consisting of 5-fluorouracil and cisplatin combined with radiation (59.8 Gy) to a patient with locally advanced esophageal cancer (T4 (left main bronchus) N2M0, stage IVa). The cancer disappeared completely after the chemoradiotherapy. However, because an esophagobronchial fistula occurred, an esophageal bypass was performed according to the method of Postlethwait. Thereafter, multiple lung metastases appeared, which we treated with paclitaxel 120-210 mg/body during a total of 23 chemotherapy treatments over more than 2 years. For a lesion that recurred in a cervical paraesophageal lymph node, we administered 60 Gy of radiation. With these combined therapies, this patient survived 50 months as an outpatient with high quality of life. It is difficult to treat patients in whom there is direct invasion of the trachea or main bronchus by esophageal cancer, and we cannot generalize about the best treatment for these patients. This case, however, highlights how to treat such a patient so that he retains a high quality of life.