Furusawa Hiroki, Hayashi Tomoyuki, Okamoto Koichi, Miyazawa Masaki, Seki Akihiro, Nakagawa Hidetoshi, Nio Kouki, Iida Noriho, Yamasita Tatsuya, Yamashita Taro
Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Kahoku, Uchinadamachi, Ishikawa, 920-0293, Japan.
Clin J Gastroenterol. 2025 Sep 12. doi: 10.1007/s12328-025-02208-w.
Esophageal cancer is a prevalent malignancy with high mortality rates worldwide, often warranting aggressive treatment modalities, such as chemoradiotherapy or radiotherapy. Although these treatments are effective, they can predispose patients to secondary malignancies, posing challenges for long-term management. Here, we present a case report detailing the development and management of secondary malignancies following radiotherapy for esophageal adenocarcinoma. A 78-year-old man presented with symptoms resulting in the diagnosis of esophageal adenocarcinoma with multiple lung metastases. Complete remission was achieved through chemotherapy with docetaxel, cisplatin, and S-1, followed by intensity-modulated radiation therapy. Seven years later, surveillance revealed a squamous cell carcinoma at the post-radiotherapy site; however, endoscopic resection was deemed challenging owing to fibrotic changes. Photodynamic therapy (PDT) with talaporfin sodium was administered, resulting in complete response without complications. This case highlights the potential for secondary malignancies following radiotherapy for esophageal adenocarcinoma and the efficacy of PDT as salvage therapy. This report underscores the importance of vigilant post-treatment surveillance and the need for tailored management strategies. Future research should focus on understanding the mechanisms of radiation-induced carcinogenesis, evaluating the long-term outcomes of PDT, and developing preventive strategies to enhance patient care and outcomes.
食管癌是一种在全球范围内普遍存在且死亡率很高的恶性肿瘤，常常需要采取积极的治疗方式，如放化疗或放疗。尽管这些治疗方法有效，但它们会使患者易患继发性恶性肿瘤，给长期管理带来挑战。在此，我们报告一例详细阐述食管腺癌放疗后继发性恶性肿瘤的发生与管理情况的病例。一名78岁男性因出现相关症状而被诊断为食管腺癌伴多发肺转移。通过多西他赛、顺铂和S-1化疗，随后进行调强放疗，实现了完全缓解。七年后，监测发现放疗部位出现鳞状细胞癌；然而，由于纤维化改变，内镜切除被认为具有挑战性。于是给予了用替拉泊芬钠进行的光动力疗法（PDT），结果实现了完全缓解且无并发症。该病例突出了食管腺癌放疗后发生继发性恶性肿瘤的可能性以及PDT作为挽救治疗的疗效。本报告强调了治疗后密切监测的重要性以及制定个性化管理策略的必要性。未来的研究应聚焦于了解辐射致癌的机制、评估PDT的长期疗效以及制定预防策略，以改善患者护理和治疗效果。
