Yura Masahiro, Koyanagi Kazuo, Hara Asuka, Hayashi Keita, Tajima Yuki, Kaneko Yasushi, Fujisaki Hiroto, Hirata Akira, Takano Kiminori, Hongo Kumiko, Yo Kikuo, Yoneyama Kimiyasu, Tamai Yoshifumi, Dehari Reiko, Nakagawa Motohito
Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan.
Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan.
World J Clin Cases. 2021 Apr 26;9(12):2801-2810. doi: 10.12998/wjcc.v9.i12.2801.
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.
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.
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.
顺铂联合5-氟尿嘧啶（CF）同步放化疗被认为是不可切除的局部晚期T4期食管鳞状细胞癌（ESCC）的标准治疗方法。近年来，诱导化疗作为一种有效的治疗策略受到关注。
我们报告了1例成功治疗的病例，患者为59岁女性，患有不可切除的局部晚期T4期ESCC，在接受多西他赛、顺铂和氟尿嘧啶（DCF）诱导化疗后，再接受两周期CF化疗，随后进行同步放化疗。最初的食管胃十二指肠镜检查（EGD）发现食管中段有一处2型进展期病变并伴有狭窄。计算机断层扫描发现原发性肿瘤，怀疑侵犯左支气管，与主动脉直接接触90°，并有上纵隔淋巴结转移。活检病理结果显示为鳞状细胞癌。我们最初采用三周期DCF进行诱导化疗，但DCF化疗后病变仍被评估为不可切除。因此，我们随后进行了同步放化疗（CF和放疗）。同步放化疗后，原发性肿瘤明显缩小，但EGD检查发现有残留肿瘤伴溃疡形成。由于患者存在一定的手术风险，我们又进行了两周期CF化疗，实现了临床完全缓解。在最后一次CF化疗后14个月，计算机断层扫描和EGD检查未发现复发，瘢痕形成部位的活检未发现癌细胞。
我们报告了1例成功的病例，该患者即使在接受DCF及随后的同步放化疗后仍有肿瘤残留，最终通过两周期额外的CF化疗实现了完全缓解。额外的CF化疗可能是诱导DCF治疗后再行同步放化疗的ESCC残留患者避免补救性手术的一种根治性治疗选择，尤其适用于高危患者。
