Multimodal radiotherapy in recurrent refractory metastatic esophageal cancer

Abstract

Background To explore the efficacy and toxicity of multimodal radical radiotherapy and systematic therapy in refractory recurrent metastatic esophageal cancer. Patient and Methods A 57-year-old man with locally advanced esophageal squamous cell carcinoma (ESCC) presented with supraclavicular lymph nodes and bone metastases six years after radical resection and adjuvant chemotherapy. After multiline systemic therapy, the tumor progressed with involvement of lymph nodes in the left neck, supraclavicular, subclavian, and axillary regions, as well as the C6 vertebral bone. The patient exhibited Horner’s syndrome on the left side as well as brachial plexus nerve injury with serious pain. Adaptive intensity-modulate radiotherapy (IMRT) combined with high-dose brachy radiotherapy (BRT), and stereotactic radiotherapy (SBRT) was applied to control local foci, together with systemic treatment using target and immunotherapy as maintenance. Results The patient showed complete remission (CR) of symptoms and signs, including the complete disappearance of the left neck metastatic lymph nodes, CR of the left upper-neck metastatic lymph nodes, and satisfactory local control of bone metastases. The progression-free survival (PFS) was more than 20 months, with CR of pulmonary metastases, satisfactory control of hepatic metastases, and PFS for lung and liver foci of over 17 months. No significant adverse events were observed, and the overall survival (OS) was more than 30 months. Conclusions Adaptive IMRT combined with high-dose brachy implantation radiotherapy and maintenance therapy can effectively improve both local control and PFS in patients with refractory recurrent metastatic esophageal cancer.