A Case of Recurrence of Esophageal Cancer to the Posterior Thoracic Paraaortic Lymph Node after Esophagectomy in which Multimodal Therapy Led to a Long-term (54 Months) Survival

Abstract

A72-year-oldwomanwhopresentedwithdifficultyinoralingestionwasdiagnosedwithcancerof the lower thoracic esophagus ＜ UICC7th-cT3N3M1(#104R), cStage IV ＞. We performed 2 courses of 5-fluorouracil + cisplatin (FP therapy) as neoadjuvant chemotherapy, followed by esophagectomy via right thoracotomy and three-field lymph node dissection. Histopathology revealed UICC 7 th-pT3N2M1(#104R)pStageIV,thatappearedtosuggestahighriskofrecurrence.Consequently,additional radiation therapy (60 Gy) targetting #104R and #101R was conducted. PET-CT scan performed 7 monthsaftertheoperationshowedabnormallyhighaccumulationofFDGtotheposteriorthoracicparaaorticlymphnode.Recurrenceoftheesophagealcancerwasconsidered,andweperformedchemoradiationtherapy(60Gy+2coursesofFPtherapy).Thereafter2coursesofweeklypaclitaxeltherapywere added.Thepatienthasbeenfreefromanyrecurrenceasof61monthsaftertheoperation. Itisdifficulttomaketherapeuticguidelinesforrecurrencetotheposteriorthoracicparaaorticlymph nodeafterradicalsurgeryforesophagealcancer.Intreatingthispatient,weonceconsideredtoperform surgical resection, but our selection to employ multimodal therapy resulted in long-term survival. It mightbebeneficialforthetreatmentthattherecurrencehadinvolvedasolitarylymphnode.