Advanced Esophageal Cancer with Esophago-bronchial Fistula Successfully Treated by Chemoradiation Therapy with Additional Endoscopic Resection: a Case Report

Abstract

Chemoradiation is potentially curative for esophageal cancer in various stages, but local failure is a major problem. The present case was a 49-year-old male diagnosed with advanced esophageal cancer with an esophago-bronchial fistula and lymph node metastasis. Histological diagnosis by biopsy was adenosquamous cell carcinoma. Chemoradiotherapy comprising intravenous infusion of cisplatin and continuous infusion of 5-fluorouracil with concurrent radiation was initiated in July 1997. In December 1997, after four courses of therapy, partial remission was obtained and the fistula closed with a remnant polypoid lesion at the primary site, which remained even after six courses of treatment. In February 1998, endoscopic polypectomy was performed for the remnant lesion and histological examination revealed that it contained adenocarcinoma cells. Thereafter, no additional treatment was performed and the patient has been disease-free for 3.5 years. This case suggests that additional endoscopic resection is an optional treatment for local failure after chemoradiation.

Clinical and Pathologic Evaluation of the Effectiveness of Neoadjuvant Chemoradiation Therapy in Advanced Esophageal Cancer Patients

“…Concurrent chemoradiation therapy (CRT), which is thought to have the strongest antitumor effect against local tumors, is an effective treatment for far‐advanced esophageal carcinoma patients [4, 5]. There are many reported patients treated only with CRT who obtained a clinical complete response (CR) and long‐term survival [6, 7], and, of course, in these cases it can be estimated that they achieved pathologic CR. CRT is also available as a preoperative neoadjuvant therapy and it can improve resectability down‐staging of local tumors infiltrating to adjacent organs (T4).…”